North Austin Medical Center Questions at Check-in Time
Posted on July 21, 2009 
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- Age
- Birth date
- Height
- Pre-Pregnancy Weight
- Current Weight
- Due Date
- First day of your last period
- Allergies
- How many pregnancies have you had?
- Are you married?
- Fathers name
- Mothers SS#
- Occupation
- Religious Preferences
- Medications mother takes
- When did you last eat?
- Do you smoke, drugs, alcohol etc.
- Have you had any medical procedures?
- Date of your first prenatal visit
- Have you taken any prenatal classes?
- Name of Pediatrician
- Do you plan on breastfeeding/Bottle Feeding?
- Do you plan on Circumcision?
- Do you want your tubes tied?
- Do you have specific dietary needs?
- Do you live in a house or apartment?
- Do you have stable electricity, AC & heat?
- Medical Family History on the mothers side
- Do you have any STD’s
- Are you an Organ Donor?
- Do you wear glasses or contacts?
- Do you need WIC?
- Who do you live with?
- Do you have an infant car seat?
- When was the last time you ate?
