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Abnormal Bleeding evaluation
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How long have you had this problem?
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Comments
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Do you still have a uterus?
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Do you still have a cervix?
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Have you gone through menopause?
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Do you have fibroids?
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Do you have pain?
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Have your menses been normal?
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Shortening time between periods?
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Lengthening time between periods?
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Heavy menses?
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Long menses (>5-7 days)
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Bleeding between periods?
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Post menopausal bleeding?
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Are you currently bleeding?
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What is your normal cycle length?
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What treatments have you tried for bleeding?
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Do you currently smoke?
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Pregnancy History
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Gravida
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Para
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Obstetrical History
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Past Medical History
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Past Surgical History
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Date of last pap smear
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HPV
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EXAM
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Pelvic Exam Normal
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External Genitalia Abnormal
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Location
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External Genitalia Comments
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Urethral Meatus Normal
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Urethral Meatus Abnormal
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Urethral Meatus Comments
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Bladder Normal
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Bladder Abnormal
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Vagina Normal
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Vagina Abnormal
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Vagina Comments
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Cervix Normal
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Cervix Abnormal
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Location
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Cervix Comments
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Uterus Normal
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Uterus Abnormal
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Uterus Comments
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Adnexa Normal
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Adnexa Abnormal
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Adnexa Comments
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Anus/Perineum Normal
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Anus/Perineum Abnormal
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Location
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Anus/Perineum Comments
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Assessment
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Plan
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Labs
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Lab Comments
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Radiology
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Radiology Comments
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Referrals
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Referral Comments
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Medication prescriptions
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