[Illustration: |Name|Age|Residence|Married or Single|No. of
Pregnancy|Date when last Child was Born|Date of Admission|Period of
Gestation|Date of Commencement of Labour|Duration of Labour, in
Hours|Nature of Delivery|Presentations|Complications of
Delivery|Operation, if any|Accidents or Diseases, if any, after
Delivery|Nature of Accident or Disease|Date of Attack|Duration|Result
and Date|Births: Single, Twins or Triplets|Infant Born Living or
Dead|Sex of Child|If infant Dead after Birth, Cause of Death, and
Date|Date of Removal from Lying-in Department|No. of Days in Lying-in
Department|Date of Discharge from Institution|Remarks|]
NOTE.—Should any death take place in a woman discharged from the
institution within a month from the time of her delivery, a record
of this death, its date, and cause, to be entered in the column of
Remarks. In the same column should be entered remarks on abnormal
configuration, or on abnormal conditions of health which might
influence the result of the delivery.
For all this provision must be made. There are scarcely two points in
common between a lying-in institution and a general hospital.