The government has a card for this, the Mother and Child Protection card that public-sector ANC runs on, which in Gujarat most families know as the Mamta card. Private clinics usually keep something looser: a case sheet, a stapled set of scan reports, and a pad the doctor writes visits on. The looseness is the problem. An antenatal record has to survive nine months, several consultants, a scan centre, a lab and one delivery night, and it has to be legible to whoever is on duty when she arrives at 3 a.m.
This page gives you a card format for a private clinic, registration, obstetric history, baseline investigations, risk assessment, immunisation and supplements, a visit-by-visit record, a counselling checklist, a birth plan and the delivery details, as an editable Word file and a print-ready PDF. No sign-up. Below it, each block is explained, with the one question that decides whether an ANC card is worth keeping at all: does it make the high-risk pregnancy visible before the emergency?
In short
- One card per pregnancy, started at registration, carried by the woman, with the clinic keeping its own copy. A card that lives in the clinic file is not a card; it is a case sheet.
- The visit table is the working part: date, weeks, weight, BP, haemoglobin, urine, fundal height and foetal heart, oedema, presentation, complaints and the next date, one row per visit, every visit.
- Risk has to be written down and revisited, not inferred. The card carries a risk category with a date, and the plan that follows from it.
- The scan entries should carry the PC-PNDT Form F number, the ANC card and the Form F register are two records of the same ultrasound and inspectors compare them.
- A card template fixes the format; software fixes the reminders. The card cannot call her about the visit she missed, the reminder worklist can.
Download the ANC card template
Three pages: registration, history, investigations, risk and immunisation; the visit record (one row per visit, with a counselling checklist); and the birth plan and delivery details. Bracketed text shows what goes in each field.
- Word template (.docx), add your letterhead, adjust the visit rows, save as your clinic’s card.
- PDF template, print-ready A4 for the card the woman carries.
Free to use and adapt. No email, no registration.
What does the government's card do that a private clinic's often doesn't?
The public-sector Mother and Child Protection card is built around a schedule and a set of thresholds: national guidance expects a minimum of four antenatal check-ups, the first within twelve weeks, with weight, blood pressure, haemoglobin and urine at each, tetanus immunisation and iron–folic acid and calcium supplementation recorded, and a stated set of high-risk criteria that trigger referral. Confirm the exact schedule your state programme follows; the point is that the card enforces it.
A private clinic’s advantage is more visits and more investigation; its weakness is that nobody enforces the structure. The template on this page borrows the public card’s discipline, the schedule, the thresholds, the risk category, the immunisation and supplement lines, and adds what a private practice actually records: the booking and anomaly scans with their Form F numbers, the GDM screen, thyroid where done, the ABHA number, and a birth plan that includes payment and insurance.
What goes on the registration page?
- Identification, ANC registration number, UHID, name, age, address and a mobile number that reminders will actually reach; the ABHA number where the woman has one.
- Obstetric history, gravida, para, living, abortions; LMP and EDD by dates and by scan; every previous pregnancy with year, outcome, mode and complications; previous caesarean with year and indication. This history is the single strongest predictor on the card.
- Baseline investigations, height, weight and BMI; blood group and Rh, with the partner’s Rh if she is Rh-negative; haemoglobin; urine albumin and sugar; blood-sugar screening; HIV, HBsAg and VDRL with consent; the dating and anomaly scans with dates, findings and Form F numbers.
- Risk assessment, the factors present, a risk category, the date it was reviewed and the plan that follows. A high-risk pregnancy that is not labelled high-risk on the card is the commonest way a clinic gets surprised.
- Immunisation and supplements, Td doses with dates; iron–folic acid and calcium with start dates and doses.
How should the visit record be laid out?
As a table, one row per visit, with the same columns every time so a missing value is visible as a blank cell rather than an absent sentence:
| Column | Why it is there |
|---|---|
| Date · weeks of gestation | Anchors everything else; makes a gap between visits visible. |
| Weight · BP | The two trends that flag pre-eclampsia and poor gain early. |
| Haemoglobin · urine albumin / sugar | Anaemia and proteinuria, the values most often tested and least often written down. |
| Fundal height · foetal heart | Growth and wellbeing at every visit, in two numbers. |
| Oedema · presentation | Late-pregnancy findings that change the delivery plan. |
| Complaints / advice · next visit · signature | What she said, what was told, when she is due back, and who saw her. |
Under the table, a counselling checklist, diet, danger signs, birth preparedness, institutional delivery, breastfeeding, family planning, newborn care, ticked and dated. It is the part assessors and programme reviewers look for, and the part that is otherwise never recorded.
What belongs in the birth plan?
The birth plan is where the ANC card stops being a medical record and becomes an operational one. It is filled towards term and it answers, in advance, the questions that get asked in a panic: where will she deliver, by what expected mode and why, who brings her and how, is a blood donor identified, and how is the delivery being paid for, cash, a package, insurance or a scheme. It ends with the danger signs explained to her in a language she understands, and a line recording that they were.
After delivery, the same page records the outcome, date, time, mode, sex, birth weight, complications, the contraception chosen, so that the card closes the pregnancy it opened, and the details flow straight into the discharge summary rather than being re-typed from the labour-room register. (Our free delivery register format is the labour room's side of the same record.)
What can a card not do?
Remind her. The visit she misses at 28 weeks is the one where the blood pressure would have been caught, and a card in her handbag does not ring her phone. That is the part of antenatal care a template cannot fix and software can: an ANC enrolment that knows the schedule, a worklist of women due this week, and WhatsApp reminders that go out with delivery tracking so the front desk knows the message landed.
MedStream’s maternity module runs the whole episode that way, one enrolment, the visit schedule, high-risk flags, a printable ANC card in English or Gujarati, and the delivery admission on the same record, and the maternity home page shows how it fits a small unit. Whichever software you evaluate, ask to see an ANC card printed from a test enrolment, and ask what happens when a visit is missed; the second answer is the one that matters.
From the people who built it
The card, printed from the record, and the reminder when she doesn't come.
In MedStream an ANC enrolment carries the schedule, the risk flags and every visit on one record, prints the card in English or Gujarati, and puts the women due this week on a reminder worklist with WhatsApp delivery tracking. Bring a test enrolment to a thirty-minute demo and watch the card print and the reminder go out.
Questions on this topic
What is the format of an ANC card?
- Registration details and obstetric history; baseline examination and investigations (blood group and Rh, haemoglobin, urine, blood sugar, HIV/HBsAg/VDRL, dating and anomaly scans); a risk assessment with a category and plan; immunisation and supplement record; a visit-by-visit table of date, weeks, weight, BP, haemoglobin, urine, fundal height and foetal heart, oedema, presentation, complaints, advice and next visit; a counselling checklist; a birth plan; and the delivery details. The free template on this page lays all of it out over three pages.
How many ANC visits are recommended in India?
- National guidance has long specified a minimum of four antenatal check-ups, the first within twelve weeks of pregnancy, then in the second trimester and twice in the third, with more for high-risk pregnancies; global guidance now favours more contacts. Confirm the schedule your state programme follows, and treat the minimum as a floor, not a target.
Is the ANC card the same as the Mother and Child Protection (MCP) card?
- The MCP card is the government's combined antenatal, delivery, postnatal and child-immunisation record used across public-sector care, in Gujarat commonly called the Mamta card. A private clinic's ANC card covers the antenatal part in the clinic's own format; the template here follows the same structure so the two can be reconciled.
Should the ANC card record the ultrasound Form F number?
- Yes. Every obstetric ultrasound generates a PC-PNDT Form F, and the ANC card's scan entries should carry the Form F number so the card, the Form F register and the monthly report describe the same scans. Inspectors compare them.
Can I use this template for my clinic?
- Yes, download the Word file, add your letterhead and registration number, adjust the visit rows, and save it as your standard card. It is free to use and adapt, with no sign-up or attribution required.