Contraceptive Management Visit
HISTORY: [textarea default="Patient requests contraception. She is not currently taking any birth control."] LMP: [date] Tobacco Use: [select value="no|yes"] EXAM: [textarea default="Vital Signs Within Normal Limits. GENERAL: Well Developed and Well Nourished Female, Alert and oriented x 3, in no distress."] ASSESSMENT/PLAN: [textarea default="discussed contraceptive means available including IUD, nuvaring, combination oral contraceptives, and implanon. She wishes to proceed with ***. Urine HCG obtained and is ***NEGATIVE*** Benefits and risks discussed with patient."]
There are 5 form elements.