Pregnancy-Related Symptoms
Onset prior to evaluation
Onset while:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Frequency: (is regular)
Duration:
Characterized as: (is contraction-like)

Pain modifiers
Relieved with
Worse with

Pregnancy History:
Gravida
Para
Ab:
LMP:
EDC: (determined by )
Gestational Age:

Specific Genitourinary Symptoms:
<-- Leakage of fluid
<-- Vaginal Bleeding
<-- Vaginal Discharge
<-- Dysuria
<-- Hematuria

Associated Symptoms:
<-- nausea
<-- vomiting
<-- headache
<-- fever

Pertinent PMH
<-- Preterm Labor
<-- Pregnancy Induced Hypertension (PIH)
<-- Gestational Diabetes
<-- STD
<-- Urinary tract infections

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Result - Copy and paste this output: