WOMEN HEALTH

Ilha Rasa - Guaraqueçaba - PR
Name:
Age:
Nº of Pregnancies:
Nº of Deliveries:
Abortion/Fetal Deaths:
Last Menstruation Date:

GINECOLOGIC CANCER
Sexual Activity Begin Age:
Number of Sexual Partners:
First Pregnancy Age:
Sexual Transmited Diseases:      YES o        NO o
Which one?

Correct Treatment?      YES o        NO o
Hygiene (nº of baths per week):
Fumo:
Sex Relations per Week:
Hormonal Oral Contaceptive:
Other Medicines:

FAMILY PLANNING
Contraceptive Method that uses or have used:
Use Time for each Method:

Correct Use:      YES o        NO o
Diseases or situation that disprove the Method:

PRENATAL
Prenatal Begin:
Nº of Consults:
High Risk:      YES o        NO o
Vaccination:
Prenatal File:      YES o        NO o
Prenatal Card:      YES o        NO o
Directing to Specialized Unit:      YES o        NO o
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