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Sexology / Human sexuality / Fertility / Yes and no / Sexual intercourse / Sexual dysfunction / Review of systems / Menopause / Sexually transmitted disease / Behavior / Reproduction / Human behavior


University of Rochester UNIVERSITY HEALTH SERVICE Preventive Care History Established Patient Date:
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Document Date: 2010-11-12 15:15:08

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File Size: 42,81 KB

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Facility

University of Rochester UNIVERSITY HEALTH SERVICE Preventive Care History Established Patient Date / /

MedicalCondition

Tetanus/Pertussis / severe headaches / allergies / HIV / Acne / Chest Pain / mumps / warts / flu / stomach pain / fainting / Hoarseness / Shortness of breath / chills / measles / chicken pox / Measles Influenza / Tetanus / recreational drug usage / herpes / sexual dysfunction / Fever / Miscarriages / Numbness / pain / Fatigue / rubella / sexually transmitted infections / Mood changes/depression / eye pain / menstrual periods vaginal itching / Frequent nosebleeds / Dizziness / Prostate cancer / Cough / illness / Constipation / Hearing loss / gonorrhea / Back pain / Varicella / Persistent diarrhea / tuberculosis / /

MedicalTreatment

birth control / IMMUNIZATIONS / VACCINATIONS / home remedies / /

Organization

University of Rochester UNIVERSITY HEALTH SERVICE Preventive Care History Established Patient Date / /

Position

last visit Dentist / nervousness Head / General / /

Product

Medication Dose/How Often Reason Medication / /

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