CD Document JSON Generator

https://jsonform-product-staging.caringhealth.com.my/

Gynaecology Infertility Note (Female)

Add Section

Update Section Sorting

Update Element Sorting

Add Element Expand

FERTILITY HISTORY

Add Element Expand

Infertility

Edit

Duration Of Marriage

Edit

Duration Of Infertility

Edit

Time Since Last Pregnancy (month)

Edit

Time Since Last Pregnancy (month)

Edit

Number And Outcome of Last Pregnancies

Edit

Number And Outcome of Last Pregnancies

Edit

Union Method

Edit

Postpartum / Post Abortal Complications

Edit

CONTRACEPTIVE HISTORY

Add Element Expand

Contraception Since Last Pregnancy (Ever Used If Primary Infertility)

Edit

Duration of Contraception Discontinuation

Edit

Date Of Last Pap Smear

Edit

Results

Edit

Abnormal Vaginal Discharge

Edit

Nipple Discharge

Edit

Other Breast Problem

Edit

OTHER FACTORS WITH POSSIBLE EFFECTS ON FERTILITY

Add Element Expand

Environmental

Edit

Diet

Edit

Smoking

Edit

Alcohol

Edit

Drug Abuse

Edit

Risk Factors (HIV / Hepatitis)

Edit

Relevant Family History

Edit

MENSTRUAL AND OVULATION HISTORY

Add Element Expand

LMP

Edit

Age At Menarche (Years)

Edit

Amenorrhea

Edit

Primary Amenorrhea

Edit

Secondary Amenorrhea

Edit

Menstrual Regularity

Edit

Average Length Of Cycle (Days)

Edit

Shortest Cycle (Days)

Edit

Longest Cycle (Days)

Edit

Menstrual Bleeding

Edit

Menstrual Category

Edit

Inter Menstrual Bleeding (Imb)

Edit

Postcoital Bleeding (Pcb)

Edit

Dysmenorrhea

Edit

PREVIOUS INVESTIGATIONS AND TREATMENTS FOR INFERTILITY

Add Element Expand

MEDICAL AND SURGICAL HISTORY WITH POSIBBLE ADVERSE EFFECTS ON FERTILITY

Add Element Expand

Systemic Disease

Edit

Medical Treatment

Edit

Allergies And Alert

Edit

Surgical Procedures

Edit

Pid

Edit

Std

Edit

Endometriosis

Edit

Cervical Problems / Procedure

Edit

PHYSICAL EXAMINATION

Add Element Expand

Physical Examination

Edit

Height (Cm)

Edit

Weight (Kg)

Edit

Bmi

Edit

B/P (Mmhg)

Edit

Systolic Pressure (Mmhg)

Edit

Diastolic Blood Pressure (Mmhg)

Edit

Significant Weight Gain (>10%) In Last One Year

Edit

General Condition and Examination

Edit

Hair Distribution

Edit

Tanner Staging (Pubic Hair)

Edit

Breast Development

Edit

Tanner Staging (Breast Female)

Edit

Breast Lump / Abnormality

Edit

Galactorrheas

Edit

Breast Examination Findings

Edit

Breast Diagram

Edit

Abdominal Examination Findings

Edit

Abdominal Diagram

Edit

PELVIC EXAMINATION

Add Element Expand

External Genitalia

Edit

Vulva

Edit

Clitoris

Edit

Hymen

Edit

Internal Genitalia

Edit

Vagina

Edit

Cervix

Edit

Uterus

Edit

Adnexa

Edit

Pelvic Examination Findings

Edit

Female Genitalia Perineum Diagram

Edit

ULTRASONOGRAPHY OF PELVIS

Add Element Expand

LMP

Edit

Cycle Day

Edit

Date Of Ultrasonography

Edit

Trans Vaginal Sonography (Tvs)

Edit

Trans Abdominal Sonography (Tas)

Edit

Uterus

Edit

Ovary

Edit

Endometrial Thickness (Mm)

Edit

HYSTEROSALPHINGOGRAM

Add Element Expand

LMP

Edit

Cycle Day

Edit

Date Of Hysterosalphingogram

Edit

Uterine Cavity

Edit

Tubal Patency

Edit

LAPAROSCOPY AND DYE TEST

Add Element Expand

LMP

Edit

Cycle Day

Edit

Date Of Laparoscopy And Dye Test

Edit

Pelvis

Edit

Tubal Patency

Edit

ADDITIONAL TEST

Add Element Expand

SIGNATURES

Add Element Expand

Back

Preview