[atlallie]

Gynecological history
+ When did your last menstrual period start?
+ Are your periods regular?
+ What kind of birth control are you using now, and what kinds have you used in the past?
+ Have you ever had an abnormal Pap smear?
+ Have you or your partner ever been diagnosed with a sexually transmitted infection?
+ Have you ever been diagnosed with pelvic inflammatory disease?
+ Have you ever been tested for HIV?
+ Are you currently in a monogamous relationship?
+ Have you ever been told you have any uterine abnormalities?
+ If you were born before 1972, do you know if your mother took DES when she was pregnant with you?
+ Have you ever had any kind of gynecological surgery?
+ Have you ever been treated for infertility?


Obstetric history
NOTE: If you've ever had any complications during a pregnancy, labor, or delivery that your practitioner is unaware of, bring the related medical records with you to your checkup. + Have you ever been pregnant before? If so,
+ Have you ever had a miscarriage? If so, how many weeks pregnant were you? Did you have a D&C? Were there complications? Do you know the cause?
+ Have you ever had an ectopic pregnancy? If so, how many weeks pregnant were you? Did you have surgery?
+ Have you ever had an abortion? If so, in which trimester? Were there any complications?
+ For each child you've given birth to: What was the birth date? Place of birth? How many weeks gestation? Gender? Birth weight? What kind of delivery? Any labor or delivery complications?
+ Have you ever had preterm labor or delivery?
+ Have you ever had a cesarean section?
+ Have you ever had any pregnancy complications, such as preeclampsia, gestational diabetes, or placental problems?


Medical history
+ Have you ever had any serious medical problems?
+ In particular, do you have diabetes, hypertension, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease (including asthma), thyroid disease, cancer, or a connective tissue disease, such as lupus or rheumatoid arthritis?
+ Has anyone in your family ever had diabetes, hypertension, a stroke, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease (including asthma), thyroid disease, cancer, or a connective tissue disease, such as lupus or rheumatoid arthritis?
+ Do you have any digestive problems?
+ Have you ever been hospitalized for any reason?
+ Have you ever had any operations? When and why? Have you ever had any problems with anesthesia?
+ Have you ever had a blood transfusion?
+ Are you being treated for any conditions right now?
+ What prescription or over-the-counter medications are you taking (including any herbs, vitamins, or supplements) and at what dose?
+ Are you allergic to any drugs? Any other allergies?
+ Have you been exposed to any infectious diseases? Is there anyone in your household who has (or had) hepatitis? Tuberculosis?


Vaccination history
NOTE: If you have a record of your immunizations, bring it with you to your appointment. + Have you ever had chicken pox or been vaccinated against it? + Did you complete your childhood vaccinations for measles, mumps, and rubella? Have you ever been tested for rubella immunity? + Have you ever been vaccinated against hepatitis B? + When was your last tetanus booster? + Are you planning a trip out of the country that might require other vaccines?

Emotional and social history
+ Have you ever suffered from any mental or emotional problems, including depression or eating disorders?
+ Have you ever been a victim of domestic violence? In your current relationship, do you ever feel threatened or are you physically or verbally abused? Have you ever been kicked, hit, or slapped? Have you ever been forced to have sex against your will?


Lifestyle questions
+ Do you smoke or use tobacco products, or are you exposed to second hand smoke?
+ Do you drink alcohol? How much and how often?
+ Do you use recreational drugs?
+ Do you drink coffee or other caffeinated beverages?
+ Do you see a dentist regularly?
+ Do you exercise regularly?
+ Do you have trouble maintaining a healthy weight?
+ Do you follow any particular kind of diet or have any dietary restrictions?
+ Do you eat a lot of fish?
+ Do you ever eat raw or undercooked meat, fish, or eggs?
+ Do you have any pets or do any gardening?
+ Do you regularly use hot tubs or saunas?
+ What do you do for a living? Do you or your partner live or work near any possible hazards, such as paints or solvents, pesticides, radiation (x-rays), lead, or mercury? Do you or your partner have any hobbies (such as ceramics) that might expose you to toxic substances?


Genetic screening
+ Has anyone in your family or your partner's family ever had:
— Hemophilia or other bleeding disorders?
— Tay-sachs disease?
— Blood diseases such as sickle cell anemia or thalassemia? Sickle cell trait?
— Muscular dystrophy?
— Down syndrome or mental retardation? Other developmental delays?
— Cystic fibrosis?
— Birth defects such as spina bifida or heart or kidney defects?
— Phenylketonuria (PKU)? — Huntington's chorea? + Does you partner have other children from a previous relationship? If so, do they have any problems?
+ What is your ethnic background?
+ What is your partner's ethnic background?
+ Is there anything else I haven't asked you that you think might be important?

[atlallie]

oops....just remembered we have a sticky by my Super-Duper co-host SavaAngel!! duh!

[SavaAngel]

Thats okay, this one is good too. Yours is a more detailed checklist!

Christina