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Diseases & Treatment
Female Patients Medical History Reports

1.    How long are you Married?
2.    Have you ever been pregnant before?
3.    Did you have abortion?
4.    Did you take contraceptive pills?
5.    Did you take Hormone Tablets?
6.    How many days once do you have a Menstrual Cycle?
7.    Date of Last Menstrual Period?
8.    Number of days Menstrual flow (or) Bleeding.
9.    Do you have the Second (or) Third weeks of the Menstrual Cycle?
10.    Do you have many menstrual Cycle in every Month?
11.    What is the colour of the Bleeding?
12.    Whether the Bleeding is Clotted (or) Watery
13.    Write about the flow of Menstruation?
14.    Is there any Whitish Discharge?


   Do you have the Whitish Discharge during the time of Menstrual Cycle?



   Do you feel the Whitish Discharge is acrid Smell and Burning Sensation?



   Is there any Itching Sensation in the Vagina?



   Is there any Stony Hardness (or) Swelling with : tenderness in the Breasts during Menstrual    Cyde?



   Is there any Abdominal Pain during Menstrual Cycle?



   Have you got Abdominal Pain one day before the Menstrual Cycle?



   Do you have the Frequent Abdominal pain?



   Do you have the Symptom of Nausea, Vomiting and Faint during the time of Abdominal pain.



   Do you have the Symptom of Indigestion and Vomiting during the Menstrual Cycle?



   Is there any pain from Hip, Thigh and Leg during the time of Menstrual Cycle?



   Do you have the Bleeding from other Orifices? : (Vicarious Menstruation), (Nose, Lungs,    Vomiting)



   Do you feel the Headache during the time of Menstrual Cycle?



   Do you have Mental Distress? (Fear, Anxiety, Tension)



   Do you feel over Weakness during Menstrual Cycle?



   i). What is your Weight?

   ii). Are you Obese person



   Do you have Regular and Nutritional Diet?



   Do you feel fever during Menstrual Cycle?



   Is there any burning Micturition?



   Is there any burning Sensation During the Inter Course?


   Have you undergone 0 & C?


   Do you have interest to do inter course with your Husband?


   Is there any Watery Secretion (or) Dryness Feeling in the Vagina during Inter Course?



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