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ROTEIO DA CONSULTA PRÉ-NATAL
ACADÊMICO:__________________________________________________________
Data____/_____/______ 
IDENTIFICAÇÃO
Nome:_________________________________________________________________
Data de nascimento:_____/_____/______ Idade:_____________________
Nome da mãe:___________________________________________________________
Endereço:______________________________________________________________
Cartão do SUS:________________________________
Está sendo acompanhada pela Enfermeira da unidade de saúde? ________
Nome da Enfermeira:______________________ ou ACS:_______________________
ANAMNESE:
Familiares: ____________________________________________________________________________________________________________________________________________________________________________________________________________Socioeconômicos:
____________________________________________________________________________________________________________________________________________________________________________________________________________Pessoais:
____________________________________________________________________________________________________________________________________________________________________________________________________________
Ginecológicos:
____________________________________________________________________________________________________________________________________________________________________________________________________________ 
Obstétricos:
G___P___A___:______________________________________________________________________________________________________________________________________________________________________________________________
 Gestação atual:
____________________________________________________________________________________________________________________________________________________________________________________________________________ 
DUM:_____/____/_____ DPP:____/____/____ IG: ____________________
EXAME FÍSICO GERAL: 
Peso:_____________ Altura:_________________ IMC:_______________________ SSVV: P.A:_________________ T°:_________ Pulso:__________ FR:__________
PELE E MUCOSAS:___________________________________________________ 
CAVIDADE ORAL:___________________________________________________
MAMAS:____________________________________________________________
ABDOME:______________________________________________________________________________________________________________________________
AU:____________________BCF/Quadrante:_______________________________ GENITÁLIA(queixas):_________________________________________________ MM:________________________________________________________________
EXAMES
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
VACINAS
____________________________________________________________________________________________________________________________________________________________________________________________________________
POLIVITAMÍNICOS
____________________________________________________________________________________________________________________________________________________________________________________________________________
ORIENTAÇÕES GERAIS
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
	
EVOLUÇÃO
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CHECK LIST
Materiais: 
Lençol (maca e para cobrir);
Rolo de papel para maca;
 Sonar;
 Fita métrica;
 Termômetro;
 Lanterna;
 Estetoscópio;
 Esfigmomanômetro;
 Espátula;
 Algodão;
Gel condutor;
Papel toalha;
 EPI’s; 
Fichas (atendimento individual, cartão da gestante, receituário/carbono);
Folder;
Álcool;
Algodão.