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Medical History
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Past Medical History
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Past Medical History Freewrite
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Past Surgical History
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Past SHx free write and Comments
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Screenings Completed this year
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Dates of Screening's
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Abnormal Screenings
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Treatment
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Menarche
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Last Menstrual Period (LMP)
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Duration of Cycle
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G/P/A
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Contraception:
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Family History
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Father's MH
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Comments
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Mother's MH
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Comments
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Paternal Hx
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Comments
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Maternal Hx
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Comments
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Social History
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Marital Status
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Sexually Active
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Smoke/Vape
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Comments
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Exercise
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Comments
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Caffeine
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Comments
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Alcohol
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Comments
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Other substances
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