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GYN History
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LMP (if n/a, leave blank)
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Menstrual cycles (leave blank if it does not apply)
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Sexually Active
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Contraception method
• • •
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Last Pap Test
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Abnormal Pap (switch on if there is a history of abnormal Paps)
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Abnormal Pap History
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OB History
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Menopause status (turn on if applicable)
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Age of menopause
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Menopause Hormone Therapy Use
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Last Mammogram (leave blank if n/a)
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Last Colonoscopy (leave blank if n/a)
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Last Labs (leave blank if n/a)
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