|
HPI:
|
last exam
|
|
LMP
|
ETOH/ TOB
|
|
Gyn issues
|
|
|
menses
|
STD's
|
|
Ovaries
|
breast biopsies/surgeries:
|
|
Uterus
|
Contraception
|
|
Cervix
|
Pap smear
|
|
additional comments/gardasil vaccine
|
Sexual activity
|
|
Last mammo
|
|
|
|
|
|
|
|
|
Ob History
|
No of Children:
|
|
First Delivery
|
|
|
Second Delivery
|
|
|
Third Delivery
|
|
|
Additional deliveries/comments:
|
|
