Female Genitourinary History
Female Genitourinary 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] Duration: [text] Characterized as: [text]. Pain modifiers Relieved with [text] Worse with [text] [select value="no|YES"] <-- worse with intercourse Pregnancy History: Gravida [text] Para [text] Ab: [text] Contraception: [text] LMP: [text] [select value="no|YES"] <-- Pregnant Now [text] Specific Genitourinary Symptoms: [select value="no|YES"] <-- Abnormal vaginal bleeding [text] [select value="no|YES"] <-- Vaginal Discharge [text] [select value="no|YES"] <-- Dysuria [select value="no|YES"] <-- Frequency [select value="no|YES"] <-- Hematuria Associated Symptoms: [select value="no|YES"] <-- decreased appetite (last ate at [text]) [select value="no|YES"] <-- nausea [select value="no|YES"] <-- vomiting [text] [select value="no|YES"] <-- diarrhea [select value="no|YES"] <-- constipation (last stool at [text]) [select value="no|YES"] <-- black or bloody stool [select value="no|YES"] <-- fever Pertinent PMH [select value="no|YES"] <-- STD [select value="no|YES"] <-- Ectopic pregnancy [select value="no|YES"] <-- Endometriosis [select value="no|YES"] <-- Ovarian Cyst [select value="no|YES"] <-- Kidney stones [select value="no|YES"] <-- Urinary tract infections [select value="no|YES"] <-- Diverticulitis Pertinent Past Surgeries: [select value="no|YES"] <-- Appendectomy [select value="no|YES"] <-- Ceserean Section [select value="no|YES"] <-- Hysterectomy [text] [select value="no|YES"] <-- Tubal ligation [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="//www.fpnotebook.com" memo="fpnotebook.com"][/conditional]
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