Pregnancy-Related Symptoms
Pregnancy-Related Symptoms Onset [text] prior to evaluation Onset while: [text] Associated Pain (0=none, 10=severe) Location: [text] Radiation: [text] Severity now (0-10): [text] Severity at worst (0-10): [text] Frequency: [text] (is [text] regular) Duration: [text] Characterized as: [text] (is [text] contraction-like) Pain modifiers Relieved with [text] Worse with [text] Pregnancy History: Gravida [text] Para [text] Ab: [text] LMP: [text] EDC: [text] (determined by [text]) Gestational Age: [text] Specific Genitourinary Symptoms: [select value="no|YES"] <-- Leakage of fluid [text] [select value="no|YES"] <-- Vaginal Bleeding [text] [select value="no|YES"] <-- Vaginal Discharge [text] [select value="no|YES"] <-- Dysuria [select value="no|YES"] <-- Hematuria Associated Symptoms: [select value="no|YES"] <-- nausea [select value="no|YES"] <-- vomiting [select value="no|YES"] <-- headache [select value="no|YES"] <-- fever Pertinent PMH [select value="no|YES"] <-- Preterm Labor [select value="no|YES"] <-- Pregnancy Induced Hypertension (PIH) [select value="no|YES"] <-- Gestational Diabetes [select value="no|YES"] <-- STD [select value="no|YES"] <-- Urinary tract infections [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"] reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="http://www.fpnotebook.com" memo="website"][/conditional]
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