RCP distributes chart forms to Nova Scotia hospitals to support the documentation of perinatal care. The RCP forms below are a sample only and contain the watermark - For Reference Only. The forms cannot be printed from the website and used in clinical practice as they can create problems for health record scanning. The version of forms below are for information and/or teaching purposes only. If you require samples or wish to order a supply please contact us or use our online order form.
To request copies of the Nova Scotia Prenatal Record use our online order form.
Chart and Prenatal Forms
| Name of Form | Form Number | Date Revised | View/Download |
|---|---|---|---|
| Newborn Weight Graph | NS_RCNW | Jan 2024 |
 RCP Newborn Weight Graph |
| Nova Scotia Prenatal Record | NS_RCPRA - NS_RCPRI | Mar 2022 |
RCP Prenatal Record |
| Preadmission Maternity Assessment | RCP/01 | Jul 2024 |
View as PDF |
| Maternal Assessment | RCP/02 | Apr 2024 |
View as PDF |
| Labour Partogram | RCP/03 | Apr 2024 |
View as PDF |
| Birth Record | RCP/04 | Apr 2024 |
View as PDF |
| Record of Parent Teaching / Mother Baby Flowsheet | RCP/05 | Jun 2012 |
View as PDF |
| Bottle Feeding Record | RCP/06a | Jun 2012 |
View as PDF |
| Maternal & Newborn Progress Notes | RCP/07 | Jun 2024 |
View as PDF |
| Newborn Admission/Discharge | RCP/08 | Nov 2020 |
View as PDF |
| Newborn Nursing Assessment | RCP/09 | Feb 2018 |
View as PDF |
| Newborn T.P.R. | RCP/10 | Jun 2024 |
View as PDF |
| Newborn Growth Charts | RCP/12 | Oct 2016 |
View as PDF |
| Daily Breastfeeding Record | RCP/6.0 | Feb 2017 |
View as PDF |
| Breastfeeding Assessment and Discharge | RCP/6.1 | Jan 2017 |
View as PDF |
| Nova Scotia Rourke Baby Record | RCP/RBR | Nov 2017 |
View as PDF |