|
DATE
|
BLOOD PRESSURE
/
|
|
AGE
|
WEIGHT
|
|
GRAVITITY
|
PARITY
|
|
LMP MONTH
|
LMP DAY
|
|
LMP YEAR
|
PREGNANCY TEST
|
|
PAP SMEAR RESULTS
|
PAP SMEAR DATE
|
|
GC/CHLAMYDIA CULTURE
|
GC/CHLAMYDIA DATE
|
|
VAGINAL CULTURE
|
VAGINAL CULTURE DATE
|
|
PREINSERTION MEDICATION
|
PARACERVICAL BLOCK
|
|
CONSENT
|
|
|
UTERINE POSITION
|
UTERINE MEASUREMENTS
|
|
TYPE OF IUD
|
IUD REMOVED IN
|
|
STRINGS
|
IMPRESSION
|
|
PLAN
|
|
