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HPI
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Annual GYN Physical Exam and Pap Smear
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Normal periods, denies vaginal discharge, lesions, abn bleeding, urinary symptoms, pelvic pain
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Comments
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Sexual Hx
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# of partners
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Sexually active with
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Condoms
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Contraceptive Use
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STD Testing
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Last Pap Smear
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Hx of STDs or HPV
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Family Hx
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Review of Systems
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Breast: WNL
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Breast Comments
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Vaginal: WNL
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Vaginal Comments
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Physical Exam
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Normal Breast Exam
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Breast Exam Comments
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Normal Vaginal Exam
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Vaginal Exam Comments
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Plan
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Follow-up Pap Smear
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Follow-up STD Testing
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Pt counseled on prevention of STDs, contraception use, diet and exercise
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If >40, follow-up mammogram results
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Follow-up in one year for annual GYN exam
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Other
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