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									                                                 Progress Notes
                                                                    Page 1
1/4/2003 PPD#1
0730     S/P NSVD, Female, 2° perineal lac., Breast-feeding.
         Feels generally well, but tired. No medical complaints.
              Voiding well. Baby doing well
         VS T=98.1, (Tmax=99.2), P=102, R=18, BP=100/65
         Breasts soft, NT
         Abd: Uterus firm, at Umbil. + 2 FB, non-tender
         Calves: no tenderness
         Lochia: Moderate, non-foul
         Perineum: Intact
         Labs: CBC pending from this AM
         A/P: Stable PPD#1
              Discussed contraception. Prefers OC’s. non-smoker. Rx
              for Triphasil 28s (3 packs) written

                                                                                                   Mike Hughey, MD
                                                                                                              PG-1




Note: These Progress Notes are for illustrative purposes only. Remember that:
  1. Not all patients will present in this fashion.
  2. Local customs may require significant modification of the Progress Note format and content.

								
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