Get the free Female Reproductive Health History (DHHS 4060F)

1. Last Name First Name MI CONFIDENTIAL 2. Patient Number 3. Date of Birth (MM/DD/YYY) Month Day North Carolina Department of Health and Human Services Division of Public Health Women's and Children's

How to fill out female reproductive health history

How to fill out female reproductive health history:

1. Begin by gathering important personal information such as your name, date of birth, and contact details. This will ensure that your health history is accurately recorded.
2. Include details about your menstrual cycle, such as the average length of your periods, the date of your last period, and any irregularities or changes you have noticed.
3. Provide information about any previous pregnancies, including the number of pregnancies you have had, the outcome of each pregnancy (whether it resulted in a live birth, miscarriage, or abortion), and any complications you experienced during pregnancy or childbirth.
4. Mention any contraceptive methods you have used in the past or are currently using, including hormonal birth control pills, intrauterine devices, condoms, or natural family planning methods.
5. Discuss any history of sexually transmitted infections (STIs) or exposure to STIs, as this can impact your reproductive health. Include information about previous STI diagnoses and treatments.
6. Be sure to mention any gynecological disorders or conditions you have been diagnosed with, such as polycystic ovary syndrome (PCOS), endometriosis, or uterine fibroids.
7. Describe any surgeries or procedures you have undergone relating to your reproductive system, such as a hysterectomy, dilation and curettage (D&C), or a tubal ligation.
8. Provide details about any medications or supplements you are currently taking that may affect your reproductive health, such as hormonal therapies or fertility drugs.
9. Mention any family history of reproductive conditions or disorders, as certain conditions can have a genetic component.
10. Lastly, it is essential to note any symptoms or concerns you may have regarding your reproductive health, such as abnormal bleeding, pelvic pain, or changes in sexual function.

Who needs female reproductive health history?

1. Women of reproductive age who are seeking medical care or planning to start a family may be asked to provide their female reproductive health history. This includes adolescent girls, women who are sexually active, women considering contraception options, and those undergoing fertility treatments.
2. Healthcare providers, including gynecologists, obstetricians, and primary care physicians, require a comprehensive health history to better understand a woman's reproductive health and provide appropriate care.
3. Researchers and public health professionals may also collect female reproductive health histories for population-level studies to identify trends, assess healthcare needs, and improve reproductive health policies and services.

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What is female reproductive health history?

Female reproductive health history includes a detailed record of a woman's reproductive health-related information such as menstrual history, pregnancies, childbirths, contraceptive use, sexually transmitted infections, and gynecological surgeries.

Who is required to file female reproductive health history?

Women are required to provide their own female reproductive health history when visiting healthcare providers, especially gynecologists or obstetricians.

How to fill out female reproductive health history?

Women can fill out female reproductive health history forms provided by healthcare providers, ensuring to provide accurate and up-to-date information about their reproductive health.

What is the purpose of female reproductive health history?

The purpose of female reproductive health history is to help healthcare providers assess and monitor a woman's reproductive health, identify any potential issues or risks, and provide appropriate care and treatment.

What information must be reported on female reproductive health history?

Information such as menstrual cycle details, pregnancies, childbirths, contraceptive methods used, history of sexually transmitted infections, and any gynecological procedures or surgeries should be reported on female reproductive health history.