Get the free Pelvic Pain Patient History Form - Alexandria Radiology

Page 1 of 8 Pelvic Pain Patient History Form Patient Names: Date of Birth: Primary Physician Referring Physician Primary Gynecologist Other provider Reason for Visit: How did you hear about Advanced

How to fill out pelvic pain patient history

How to fill out pelvic pain patient history:

1. Begin by gathering personal information such as the patient's full name, age, contact information, and primary care physician.
2. Ask about the onset of the pelvic pain, including the date of initial symptoms and any triggers or events leading up to the pain.
3. Inquire about the location and intensity of the pain. Ask the patient to describe the sensations they are experiencing and if the pain radiates to other areas.
4. Assess the duration of the pain, including how long each episode lasts and if there are any patterns or fluctuations in the pain.
5. Determine if there are any aggravating or relieving factors for the pain, such as certain positions, activities, or medications.
6. Obtain a detailed medical history, including any previous diagnoses, surgeries, or treatments related to pelvic pain.
7. If applicable, ask about the patient's menstrual cycle, including the regularity, any changes in flow, and the presence of any associated symptoms.
8. Inquire about the patient's sexual history, including any sexually transmitted infections (STIs), contraceptive methods used, and any previous or current pregnancies.
9. Assess the patient's bowel and bladder habits, including any changes or abnormalities in frequency, urgency, or consistency.
10. Discuss the impact of pelvic pain on the patient's daily life, including any limitations in activities, relationships, or work.
11. Lastly, be sure to discuss any additional concerns or symptoms the patient may have related to their pelvic pain.

Who needs pelvic pain patient history:

1. Healthcare providers, including doctors, nurses, and specialists, need the pelvic pain patient history to evaluate and diagnose the underlying cause of the pain.
2. Researchers and academics may require pelvic pain patient history to conduct studies and contribute to ongoing research in the field.
3. Patients themselves may also benefit from understanding their own pelvic pain patient history to monitor symptoms, track progress, and communicate effectively with healthcare providers.

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What is pelvic pain patient history?

Pelvic pain patient history includes details about the patient's symptoms, medical history, previous treatments, and any relevant test results.

Who is required to file pelvic pain patient history?

Healthcare providers, doctors, or specialists involved in the care of the patient are required to file the pelvic pain patient history.

How to fill out pelvic pain patient history?

Pelvic pain patient history can be filled out by gathering information from the patient, reviewing medical records, and documenting relevant details in the patient's file.

What is the purpose of pelvic pain patient history?

The purpose of pelvic pain patient history is to provide healthcare providers with a comprehensive overview of the patient's condition, which helps in making an accurate diagnosis and creating an effective treatment plan.

What information must be reported on pelvic pain patient history?

Information such as the patient's symptoms, medical conditions, medications, allergies, surgical history, and family medical history must be reported on pelvic pain patient history.