May we have your permission to instruct our nurses to visit Mrs. ...... in accordance with our routine, and report each visit to you?

A prompt reply on the enclosed slip will be greatly appreciated.

Cordially yours,

Form for report sent after each nursing: visit to the patient’s doctor, either privately engraved or the hospital resident.

PRENATAL VISITS

Name of patient, District, Date,

Address, Nurse, Agency,

T P R, Nipples: Erect, Flat or inverted, Edema: Face, Feet, Legs.

Varicose veins, Dyspnoea, Spots before eyes, Nausea or vomiting, A.M., All day.

Headache, Constipation, Diarrhea, Vaginal discharge: White, Yellow, or Bloody.