A summary of the stay, the final health check for mother and baby, and the going-home plan that follows. Use this document to align everyone — family, pediatrician, and our care team — on next steps.
Mother — Final Health Check
Incision / perineal status:
Recommendation for the mother going forward:
Not established — referral arranged:
Recommendations for the mother going forward:
Baby — Final Health Check
Weight change from birth:
Pediatrician handoff date:
Handover date to pediatrician:
Feeding plan for the next 4 weeks:
Sleep schedule and routines:
24-hour newborn helpline shared:
Lactation consultant scheduled:
Postpartum check-up scheduled:
Mental wellness resources shared:
Family informed of the care plan:
Lactation consultant — name:
Lactation consultant — contact:
Postpartum doula — contact:
Mental health specialist — name:
Mental health specialist — contact:
Traditional medicine practitioner — name:
Traditional medicine practitioner — contact:
Would you stay with us again?
Would you refer us to family or friends?
Testimonial we may share (optional):
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Thank you for trusting us during these precious first weeks. We wish your family a calm, joyful homecoming — and we are here whenever you need support.
Authorized representative — printed name:
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