Stress Urinary Incontinence (SUI) in Women: History

History Templates

Onset and setting: Precipitating events: The frequency of occurrence: Nocturia?: Urgency?: Severity: Pad use?: Effects on ADLs: Patient denies: Hesitancy, slow stream, post micturition leakage, position-dependent micturition, and dysuria. PMH: No medical or neurologic...

Syncope, History

History Templates

Onset: Patient was: Associated symptoms: Pertinent ROS: The patient denies CP, palpitations, SOB, prodrome, HA. There were no provocative factors like exertion, position change, eating, coughing, sneezing, swallowing, anxiety, pain, defecation, micturition. No aura,...

Sports Physical / Pre-participation Physical Evaluation: History

History Templates

Patient has no significant PMH, PSH, FH, SH, takes no medications, and has no allergies. Specifically, personal and family cardiovascular histories are negative: No history of exertional chest pain or discomfort, No excessive exertional or unexplained dyspnea or...

Infertility, HPI (Male)

History Templates

-Age:___ -Prior paternity?:___ -Coital frequency:_____ -Sexual dysfunction?: No -Duration of infertility:____ -Any previous infertility evaluation and treatment? (if so, results): None -PMH (past and current):____ -Episodes of STIs:_____ -PSH: No hx of GU or inguinal...

Infertility, HPI (Female)

History Templates, OB/GYN

-Age:___ -Gravidity, parity, pregnancy outcomes:____ -Any pregnancy associated complications? : None -Cycle length and characteristics: _______ -Dysmenorrhea (onset and severity)? : None -Coital frequency:_____ -Sexual dysfunction?: No -Duration of infertility:____...

Contraception, Birth Control, Family Planning: History

History Templates

-The patient is sexually active and desires birth control. -Age of menarche:_____ -She is having regular menstrual periods with no cramps. -Periods occur about every 28 days or 1 month. -The average length of each period (in days):_______ -Menstrual flow is moderate,...