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Pellet Insertion - Female
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Female patient presents for hormone pellet insertion. She denies active infection, bleeding disorders, or allergy to local anesthetic. She denies use of blood thinners or anticoagulants. Current meds reviewed.
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Initial vs Repeat
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SUBJECTIVE
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Perimenopause / Menopause Symptoms Include:
• • •
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Pertinent Medical / Surgical / Social History / Family History
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OBJECTIVE
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Height
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Weight
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Blood Pressure
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Temperature
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Focused Physical Exam
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General
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Female Only
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Last Pap Smear
• • •
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Date of Last Mammogram
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Hysterectomy
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Ovaries
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Labs
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FSH
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LH
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Estradiol
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Estrone
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Progesterone
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SHBG
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Testosterone
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Free Testosterone
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Lab results are:
• • •
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Pellet Insertion Procedure
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Pre-procedure discussion
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Insertion Site
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Skin Prepped with
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Local Anesthesia
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Procedure
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Pellets Inserted
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Estradiol
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Testosterone
• • •
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ASSESSMENT
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PLAN
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Diagnosis(es):
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Bio-Identical Hormone Therapy - Pellet Insertion (as described above)
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Progesterone
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Post Procedure Instructions Provided (written & verbal):
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New Text Field
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Signature
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