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Female Genitourinary History
Nov 23, 2010
•
Mark Morgan
categories:
Female Health
Subjective/History
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
no
YES
<-- worse with intercourse
Pregnancy History:
Gravida
Para
Ab:
Contraception:
LMP:
no
YES
<-- Pregnant Now
Specific Genitourinary Symptoms:
no
YES
<-- Abnormal vaginal bleeding
no
YES
<-- Vaginal Discharge
no
YES
<-- Dysuria
no
YES
<-- Frequency
no
YES
<-- Hematuria
Associated Symptoms:
no
YES
<-- decreased appetite (last ate at
)
no
YES
<-- nausea
no
YES
<-- vomiting
no
YES
<-- diarrhea
no
YES
<-- constipation (last stool at
)
no
YES
<-- black or bloody stool
no
YES
<-- fever
Pertinent PMH
no
YES
<-- STD
no
YES
<-- Ectopic pregnancy
no
YES
<-- Endometriosis
no
YES
<-- Ovarian Cyst
no
YES
<-- Kidney stones
no
YES
<-- Urinary tract infections
no
YES
<-- Diverticulitis
Pertinent Past Surgeries:
no
YES
<-- Appendectomy
no
YES
<-- Ceserean Section
no
YES
<-- Hysterectomy
no
YES
<-- Tubal ligation
display/hide references
reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook
fpnotebook.com
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