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    Francisco Q. Duque Foundation College of Medicine Name of Preceptor: Name of Consultant

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    Monique Angela Turingan Gangan
    This document contains a gynecologic and obstetric history form for a patient visit. It includes sections for general data, chief complaint, history of present illness, menstrual history, obstetric history, contraceptive history, and physical exam findings. The physical exam section includes vital signs, skin, head/eyes/ears/nose/mouth, neck, chest, cardiovascular, abdominal, genitourinary, neurological, and clinical impression sections. The clinical impression notes the patient is a 39 week pregnant grand multiparous woman in early labor.

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    Francisco Q. Duque Foundation College of Medicine Name of Preceptor: Name of Consultant

    Uploaded by

    Monique Angela Turingan Gangan
    40 views4 pages
    This document contains a gynecologic and obstetric history form for a patient visit. It includes sections for general data, chief complaint, history of present illness, menstrual history, obstetric history, contraceptive history, and physical exam findings. The physical exam section includes vital signs, skin, head/eyes/ears/nose/mouth, neck, chest, cardiovascular, abdominal, genitourinary, neurological, and clinical impression sections. The clinical impression notes the patient is a 39 week pregnant grand multiparous woman in early labor.

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    This document contains a gynecologic and obstetric history form for a patient visit. It includes sections for general data, chief complaint, history of present illness, menstrual history, obstetric history, contraceptive history, and physical exam findings. The physical exam section includes vital signs, skin, head/eyes/ears/nose/mouth, neck, chest, cardiovascular, abdominal, genitourinary, neurological, and clinical impression sections. The clinical impression notes the patient is a 39 week pregnant grand multiparous woman in early labor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    40 views4 pages

    Francisco Q. Duque Foundation College of Medicine Name of Preceptor: Name of Consultant

    Uploaded by

    Monique Angela Turingan Gangan
    This document contains a gynecologic and obstetric history form for a patient visit. It includes sections for general data, chief complaint, history of present illness, menstrual history, obstetric history, contraceptive history, and physical exam findings. The physical exam section includes vital signs, skin, head/eyes/ears/nose/mouth, neck, chest, cardiovascular, abdominal, genitourinary, neurological, and clinical impression sections. The clinical impression notes the patient is a 39 week pregnant grand multiparous woman in early labor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    LYCEUM NORTHWESTERN UNIVERSITY

    Francisco Q. Duque Foundation


    College of Medicine
    MONIQUE ANGELA T. GANGAN
    Doctor of Medicine III

    Name of Preceptor:
    Name of Consultant:

    GYNECOLOGIC AND OBSTETRIC HISTORY


    Case No.
    Date of Interview:
    I.

    GENERAL DATA:
    Informant and Reliability:

    II.

    CHIEF COMPLAINT:

    III.

    HISTORY OF PRESENT ILLNESS:

    IV.

    MENSTRUAL HISTORY:

    V.
    VI.
    VII.
    VIII.
    IX.
    X.
    XI.
    XII.

    XIII.

    OBSTETRIC HISTORY:
    CONTRACEPTIVE HISTORY:
    SEXUAL HISTORY:
    MEDICAL HISTORY:
    SURGICAL HISTORY:
    FAMILY HISTORY:
    SOCIAL, PERSONAL and ENVIRONMENTAL HISTORY:
    REVIEW OF SYSTEMS:
    A. HEENT
    B. CARDIOVASCULAR
    C. RESPIRATORY
    D. GASTOINTESTINAL TRACT
    E. GENITOURINARY TRACT
    F. NEUROMUSCULAR
    G. PSYCHIATRIC
    H. DEPRESSION
    I. PHYSICAL ABUSE

    PHYSICAL EXAMINATION
    GENERAL SURVEY:
    Vital Signs:
    Blood Pressure: mmHg
    Pulse Rate: beats per minute

    Respiratory Rate: cycles per minute


    Temperature (axillary): C
    Height: cms
    Weight: kilograms
    SKIN:
    HEENT:
    a. Skull and Scalp
    b. Eyes
    c. Ears
    d. Nose
    e. Mouth
    f. Neck
    THORAX AND LUNGS:
    CARDIOVASCULAR:
    ABDOMEN:
    Leopolds Maneuver:
    LM1 (Fundal grip):
    LM2 (Umbilical grip):
    LM3 (Pawliks grip):
    LM4 (Pelvic grip):
    GENITOURINARY and PELVIC EXAM:
    PERIPHERAL VASCULAR SYSTEM:
    MUSCULOSKELETAL:
    NEUROLOGICAL:
    XIV.

    CLINICAL IMPRESSION

    G6P5 (5005), Pregnancy Uterine, 39 weeks AOG, cephalic, in early


    labor, grand multiparity

    G6P5 (5005)

    Pregnancy Uterine
    39 weeks AOG
    Cephalic

    In early labor

    Grand multiparity
    XV.
    XVI.
    XVII.

    DIFFERENTIAL DIAGNOSES:
    WORK UPS:
    MANAGEMENT:

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