Female Genitourinary Symptoms
Onset prior to evaluation
Onset while:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as: .

Pain modifiers
Relieved with
Worse with
<-- worse with intercourse

Pregnancy History:
Gravida
Para
Ab:
Contraception:
LMP:
<-- Pregnant Now

Specific Genitourinary Symptoms:
<-- Abnormal vaginal bleeding
<-- Vaginal Discharge
<-- Dysuria
<-- Frequency
<-- Hematuria

Associated Symptoms:
<-- decreased appetite (last ate at )
<-- nausea
<-- vomiting
<-- diarrhea
<-- constipation (last stool at )
<-- black or bloody stool
<-- fever

Pertinent PMH
<-- STD
<-- Ectopic pregnancy
<-- Endometriosis
<-- Ovarian Cyst
<-- Kidney stones
<-- Urinary tract infections
<-- Diverticulitis

Pertinent Past Surgeries:
<-- Appendectomy
<-- Ceserean Section
<-- Hysterectomy
<-- Tubal ligation
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Result - Copy and paste this output: