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Gynaecology Oncology Clerking Sheet

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PATIENT INFORMATION

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Height

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Weight

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Bmi

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Marital Status

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Para

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Lcb

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Occupation

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REFERRAL

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MENSTRUAL HISTORY

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PATIENT HISTORY

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Brief History (Chronology Of Events)

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Previous Other Cancers

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Previous Other Cancers Method

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Medical Problems

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Medical Problems Method

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Surgical History

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Surgical History Method

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Previous Surgical Finding

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Allergies And Alert

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Family History Of Cancer

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Other History

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PREVIOUS INVESTIGATION

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Laboratory

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Pap Smear

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Pipelle / Hysteroscopy DD&C (For Uterine Cancer)

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Biopsy (For cervical cancer / vaginal / vulvar cancer)

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For Suspected Ovarian Cancer Patients

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Radiology

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Ultrasound Date

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Place

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Findings

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Ct Scan Date

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Place

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Findings

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MRI Date

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Place

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Findings

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PET Scan Date

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Place

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Findings

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Other Procedures

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SYMPTOMS

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GENERAL EXAMINATION

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Vital Signs & Other Observations

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General Condition and Examination

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System Examination

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Abdominal

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Perineum Ultrasound

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DIAGNOSIS

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MANAGEMENT

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SIGNATURES

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