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ConfidentialLabelNorth Carolina Department of Health and Human Services Division of Public Health Women's and Children's Health SectionFEMALE REPRODUCTIVE HEALTH HISTORY Date: A. GENERAL INFORMATION
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How to fill out female reproductive health history

How to fill out female reproductive health history
01
Start by gathering all relevant information about the individual's reproductive health, including their medical history, any past or current conditions, any medications they are taking, any surgeries or procedures they have had, and any family history of reproductive health issues.
02
Begin filling out the female reproductive health history form by providing the individual's basic information such as their name, date of birth, contact information, and any relevant identification numbers.
03
Move on to recording the individual's menstrual history, including the age at which they started menstruating, the regularity of their menstrual cycles, and any associated symptoms or issues such as heavy bleeding or severe pain.
04
Document any previous or current reproductive health conditions or concerns that the individual has experienced, such as irregular periods, endometriosis, polycystic ovary syndrome (PCOS), or sexually transmitted infections (STIs). Include any treatments or medications that have been prescribed.
05
Record any surgeries or procedures the individual has undergone related to their reproductive health, such as hysterectomy, tubal ligation, or fertility treatments.
06
Ask about the individual's contraceptive use, including the methods they have used in the past or are currently using, any issues or side effects experienced, and their preferences for future contraception.
07
Inquire about the individual's sexual history, including the number of sexual partners, any history of unprotected sex, and any history of sexual dysfunction or concerns.
08
Finally, include any relevant family history of reproductive health issues, such as a family history of breast cancer, ovarian cancer, or infertility.
09
Encourage the individual to ask any questions or provide additional information they feel is important for their reproductive health history.
Who needs female reproductive health history?
01
Female reproductive health history is needed by healthcare professionals like gynecologists, obstetricians, and primary care physicians.
02
Women who are seeking reproductive healthcare, such as birth control consultations, fertility evaluations, or prenatal care, need to provide their reproductive health history.
03
Individuals with existing reproductive health conditions or concerns should also maintain and provide their reproductive health history for ongoing management and treatment.
04
Patients participating in reproductive health research studies or clinical trials may be asked to provide their reproductive health history for assessment and analysis.
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What is female reproductive health history?
Female reproductive health history refers to a record of a person's menstrual history, pregnancies, contraception use, sexually transmitted infections, and other related medical information.
Who is required to file female reproductive health history?
Women of reproductive age are typically required to provide their female reproductive health history.
How to fill out female reproductive health history?
Female reproductive health history can be filled out by completing a form provided by a healthcare provider or reproductive health clinic.
What is the purpose of female reproductive health history?
The purpose of female reproductive health history is to track and monitor a person's reproductive health throughout their life.
What information must be reported on female reproductive health history?
Information such as menstrual cycle length, last menstrual period, pregnancies, contraceptive use, and any history of sexually transmitted infections must be reported on female reproductive health history.
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