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Past Pregnancies
|
|
|
Date
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Gestational Age
|
|
Weight
|
Type of Delivery
• • •
|
|
Hours in labor
|
Doctor
|
|
Hospital
|
Remarks
|
|
Current Pregnancy (See Custom Vitals)
|
|
|
Past Medical and Family Medical History
|
|
|
Medical History
• • •
|
Comments
|
|
Family Medical History
• • •
|
Comments
|
|
Tobacco Use
|
If so, how many cigs per day
|
|
Alcohol Use
|
Street Drug Use
|
|
Hx of STDs
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Hx of Abnormal Paps
|
|
Surgical Hx
|
|
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Genetic Screening
|
|
|
Genetic Screening (Negative)
• • •
|
Comments
|
|
Trimester Screening
|
|
|
What trimester?
|
New Single Select
|
|
Antibody Screen
|
|
