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Well Woman Encounter HPI
Mar 3, 2019
•
Mark Morgan
categories:
Subjective/History
Female Health
Use with well woman questionnaire
yo G
P
with LMP of
here for well-woman exam.
-Last Pap-
years ago. Results:
normal
other-
-Hx of abnormal Pap test:
no
YES
-Menarche at age
-Age of menopause:
not yet reached
started withing past 1/2yrs
-Frequency of menstrual cycles- every
days?
-Menstrual cycle regularity-
regular
irregular
-Duration of menses-
days
-Amount of bleeding on heaviest days-
pads/tampons per day
-Between cycle bleeding-
no
YES
-Unusual vaginal discharge-
no
YES
-Sexually active-
no
Yes
-Number of sexual partners in past year *
*
-Current method(s) of birth control?
None
Condoms
Withdrawal method
Calendar method (timing intercourse around ovulation)
Birth control pills
Birth control patch (OrthoEvra)
Vaginal ring (NuvaRing)
Injection (DepoProvera)
Diaphragm
Nexplanon
Mirena
Tubal Ligation
Hysterectomy
Post-menopausal
Other-
-History of STD?-
no
YES
-Problematic hot flashes-
no
YES
-Currently on hormone replacement-
no
YES
-Smoking-
no
YES
-Hx of breast problems-
no
YES
-Last mammogram-
n/a
date-
-Reports being abused-
no
YES
-Feels safe at home?
yes
NO
-Family history of:
--Breast cancer-
no
YES
--Ovarian cancer-
no
YES
--Heart disease-
no
YES
--Osteoporosis-
no
YES
--Diabetes-
no
YES
--Other cancers-
no
YES
--Colon cancer-
no
YES
--Uterine cancer-
no
YES
-Allergies-
NKDA
listed-
-Pain during your usual period:
1
2
3
4
5
6
7
8
9
10
/10
-Pain during sex:
1
2
3
4
5
6
7
8
9
10
/10
-PMS (premenstrual tension syndrome):
1
2
3
4
5
6
7
8
9
10
/10
Other concerns:
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