% if (!isEmpty) { %>
Name
<%= profile.nameFirst %> <%= profile.nameLast %>
Last Menstrual Period (mm/dd/yyyy)
<%= formatDate(new Date(profile.lmp)) %>
Estimated Due Date (mm/dd/yyyy)
<%= formatDate(new Date(profile.edd)) %>
<%= profile.noOfPregs %> <%= pregnancyText %>
<%= profile.noOfDeliveries %> <%= deliveryText %>
Weight Before Pregnancy (pounds)
<%= profile.wbp %>
Current Weight (pounds)
<%= profile.currWgt %>
OB Provider
<%= profile.obProvider %>
OB Contact Info (<%= contact.contactType.toString() %>)
<%= contact.contactInfo.toString() %>
Maternity Care Coordinator (MCC)
<%= profile.mcc %>
MCC Phone Number
<%= profile.mccContact %>
Condition
<%= diagnosis.diagnosisName %>
Comments
<%= diagnosis.comments %>
Date Condition Began (mm/dd/yyyy)
<%= formatDate(new Date(diagnosis.onsetDate)) %>
Status
<% if(diagnosis.status) { %> Past <% } else { %> Current <% } %>
Medication Name
<%= medication.medicationName %>
Type of Medication
<%= medication.medicationType %>
Currently Taking
<% if(medication.currentlyTaking) { %> Yes <% } else { %> No <% } %>
Strength
<%= medication.strength %>
Frequency Taken
<%= medication.frequencyTaken %>
Instructions
<%= medication.instructions %>
Reason For Taking
<%= medication.reasonForTaking %>
Refills Remaining
<%= medication.refillsRemaining %>
Rx Number
<%= medication.rxNumber %>
Prescriber
<%= medication.prescriber %>
Pharmacy Name
<%= medication.pharmacyName %>
Pharmacy Phone Number
<%= medication.pharmacyPhoneNumber %>
Last Refill Date (mm/dd/yyyy)
<%= formatDate(new Date(medication.lastRefillDate)) %>
Start Date (mm/dd/yyyy)
<%= formatDate(new Date(medication.startDate)) %>
Stop Date (mm/dd/yyyy)
<%= formatDate(new Date(medication.stopDate)) %>
Side Effects
<% if(medication.unwantedSideEffects) { %> Yes <% } else { %> No <% } %>
Describe Side Effects
<%= medication.sideEffectsComment %>
Comments
<%= medication.comments %>
Allergy
<%= allergies.allergy %>
Allergy First Occurred (mm/dd/yyyy)
<%= formatDate(new Date(allergies.firstOccurred)) %>
Rash
Yes
Hives
Yes
Breathing Problems
Yes
Vomiting
Yes
Swelling
Yes
Other
Yes
Describe Other Reaction
<%= allergies.otherReactions %>
Severity
<%= allergies.severity %>
Describe Treatment
<%= allergies.description %>
Has a physician confirmed this allergy?
<% if(allergies.diagnosed) { %> Yes <% } else { %> No <% } %>
Provider Who Diagnosed Allergy
<%= allergies.provider %>
Facility Where Diagnosed
<%= allergies.facility %>
Comments
<%= allergies.comments %>
Blood Type
<%= labs.bloodType %>
Rh Type
<%= labs.rhType %>
Antibody Screen
<%= labs.antibodyScreen %>
Pap Smear
<%= labs.papSmear %>
Pap Smear Comment
<%= labs.papSmearComment %>
Rubella (German Measles)
<%= labs.rubella %>
Varicella (Chicken Pox)
<%= labs.varicella %>
Hepatitis B Surface Ag
<%= labs.hepatitisB %>
Gonorrhea
<%= labs.gonorrhea %>
Chlamydia
<%= labs.chlamydia %>
Urine Culture
<%= labs.urineCulture %>
RPR (Syphilis)
<%= labs.rpr %>
Glucose Tolerance
<%= labs.glucoseTolerance %>
Result
<%= labs.gttStatus %>
Glucose Level
<%= labs.glucoseLevel %>
Group B Strep
<%= labs.groupBStrep %>
Name of Test
<%= test.testName %>
Date of Test (mm/dd/yyyy)
<%= formatDate(new Date(test.testDate)) %>
Results for Test
<%= test.results %>
Date of Ultrasound
<%= formatDate(new Date(ultraSound.ultrasoundDate)) %>
Estimated Fetal Weight
<%= fetus.efw.weight %> <% if (fetus.efw.metric) { %> lbs <% } else { %> kg <% } %>
Estimated Gestational Age
<% } %><% var weekTxt = 'weeks' var dayTxt = 'days'; if(fetus.ega.weeks !== "") { %> <% if (fetus.ega.weeks <= 1) { var weekTxt = 'week'; } %> <%= fetus.ega.weeks %> <%= weekTxt %> <% } if(fetus.ega.days !== "") { %> <% if (fetus.ega.days <= 1) { var dayTxt = 'day'; } %> <%= fetus.ega.days %> <%= dayTxt %><% } %>
Estimated Due Date by Ultrasound
<%= formatDate(new Date(fetus.ultrasoundEDD)) %>
Comments
<%= fetus.comments %>
Date of Test (mm/dd/yyyy)
<%= formatDate(new Date(geneticscreening.testDate)) %>
Genetic Counseling
Yes
MSAFP/AFP4/Quad screen
Yes
Amniocentesis
Yes
Down Syndrome
Yes
Sickle Cell Disease and Sickle Cell Trait
Yes
Canavan Disease
Yes
Cystic Fibrosis
Yes
Chorionic Villus Sampling (CVS)
Yes
Tay Sachs
Yes
Thalassemia
Yes
Other
Yes
Other Test Name
<%= geneticscreening.otherTestName %>
Result of Test
<%= geneticscreening.testResult %>
Notes
<%= geneticscreening.testNotes %>
Flu Shot Last Administered (mm/dd/yyyy)
<%= formatDate(new Date(vaccinations.fluShotLastAdmin)) %>
Flu Shot Next Due (mm/dd/yyyy)
<%= formatDate(new Date(vaccinations.fluShotNextDue)) %>
Tdap Last Administered (mm/dd/yyyy)
<%= formatDate(new Date(vaccinations.tdapLastAdmin)) %>
Pregnancy Outcome
<%= outcome.outcome %>
Comments For Other Outcome
<%= outcome.otherOutcome %>
End Date of Pregnancy (mm/dd/yyyy)
<%= formatDate(new Date(outcome.endDate)) %>
Infant's Sex
<% if(outcome.sex) { %> Male <% } else { %> Female <% } %>
Weight (lbs)
<%= outcome.weight %>
Length (inches)
<%= outcome.length %>
First Name
<%= outcome.firstName %>
<%= outcome.lastName %>
Last Name
Comments About Pregnancy Outcome
<%= outcome.comments %>