HISTORY:
Presents for a contraceptive renewal
Current contraception: for the last years
Satisfaction:
Tolerance:
Adherence: , missed dose
Desire for pregnancy in the next year:
Sexual activity:
Condom use:
History of STIs:
STI risk factors:
Last Pap smear: ago
HPV vaccination:
Last menstrual period: ago
Menstrual cycles: days,
Menstrual symptoms:
Social history:
Smoking: , pack-years
Alcohol: , drinks per
Recreational drugs: ,
Contra-indications to estrogens:
Contra-indications to progesterone:
EXAM:
General appearance:
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Neck:
Heart: ,
Lungs: ,
Breasts: -R: , -L:
Abdomen: , , ,
Pelvic: vulva , vagina , cervix , uterus , adnexa ,
ASSESSMENT:
PLAN:
- Pregnancy test
- STI screening
- Pap smear
-
-
-
- Counseling on proper use of contraceptive method
- Counseling on emergency contraception
- Counseling on condom use for STI prevention
- Follow-up in
- Return if side effects occur