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REFERRAL FORM f. 204.231.2214 p. 204.632.6340 PLEASE COMPLETE ALL SECTIONS. Date of fax: / / 20 daymonthyearDate received: / / 20 patients name: monthyearDate of birth: / / monthyearAddress: Phone
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How to fill out bstetrical istory p s

01
Start by gathering all necessary information and medical records related to your obstetrical history.
02
Begin with filling out your personal information such as name, date of birth, contact details, and address.
03
Provide details about your previous pregnancies, including the number of pregnancies, dates, and outcomes (live birth, miscarriage, stillbirth, etc.).
04
Mention any complications or medical conditions you experienced during your pregnancies, such as gestational diabetes, preeclampsia, or placenta previa.
05
Include information about any surgeries or medical procedures related to your obstetrical health.
06
Indicate if you have any known genetic conditions or a family history of genetic disorders.
07
Provide details about any medications or supplements you are currently taking or have taken during your pregnancies.
08
Don't forget to mention any allergies or adverse reactions you may have had to medications or anesthesia during childbirth.
09
Include information about any pre-existing medical conditions that may impact your obstetrical care, such as hypertension, diabetes, or thyroid disorders.
10
Finally, review the completed form for accuracy and completeness before submitting it to your healthcare provider.

Who needs bstetrical istory p s?

01
Anyone who is pregnant or planning to become pregnant needs to fill out an obstetrical history form.
02
This form helps healthcare providers understand the patient's previous pregnancies, medical conditions, and potential risk factors prior to providing obstetrical care.
03
It allows healthcare professionals to customize the care and management plan based on the individual's specific needs and history.
04
Therefore, it is important for pregnant women to accurately fill out this form to ensure safe and appropriate care during pregnancy.
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Obstetrical history is a record of a woman's past pregnancies, deliveries, and any complications that occurred during those pregnancies.
Obstetricians or healthcare providers are typically required to document obstetrical history for their patients.
The obstetrical history form usually includes questions about past pregnancies, deliveries, miscarriages, stillbirths, and any complications that occurred.
The purpose of obstetrical history is to provide healthcare providers with important information about a woman's past pregnancies to help guide current and future prenatal care.
Information such as the number of pregnancies, types of deliveries, any complications during pregnancies, and any current or past medical conditions relevant to pregnancy are typically reported on obstetrical history forms.
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