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Sexual history
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Currently sexually active
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Ever been sexually active
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# of sex partners currently
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# of sex partners in past year
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Sex partner gender
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Protection use
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Previous STI
• • •
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Previous STI comments
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Comments
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Gynecologic History
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LMP
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Cycle length
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Dysmenorrhea
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Dysmenorrhea details
• • •
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Menorrhagia
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Menorrhagia details
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Menarche
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Menopause
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Comments
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Obstetric History
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Currently attempting pregnancy?
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Total pregnancies
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Full-term children
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Premature children
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Abortions
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Living children
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Comments
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