Your Annual Gynecology Exam
Going to see the gynecologist every year is more than just a pap smear, breast exam, and
pelvic exam. This is a great opportunity for your doctor to ensure your medical well-being. Today's
medical environment puts a premium on time. If you have not already noticed there is pressure on today's
practitioner to see more patients in less time. This
short-changes the patient from getting a complete
examination. I have created a form for use in my office that helps gather information about a patient's medical
history that is complete and well organized. It asks for a great deal of information, but is designed in
such a way that a health care provider can quickly skim the answers to identify areas in need of additional attention.
Patients are screened for various conditions including domestic violence, alcoholism, depression, genetic abnormalities,
urinary incontinence, osteoporosis, and medical planning. The form includes areas for a complete family
history, medical and surgical history, obstetric history, review of systems, medications, and allergies.
A comprehensive gynecologic questionnaire is included. The patient is queried regarding the need for additional
screening examinations and vaccinations. I am interested in optimizing this form, so your suggestions
are greatly appreciated.
I would hope that patients and providers alike could benefit from this form, so I am sharing it with everyone to
use. Hope you like it.
Download the Ultimate Annual Exam Office Form: annual.pdf *
Comments and suggestions are appreciated: Please e-mail me, Geffrey H. Klein, MD, at Geffrey.Klein@obgyn.net
*The form is in Adobe Acrobat form. The Acrobat Reader allows anyone to view, navigate, and print documents in the Adobe® Portable Document Format (PDF). Adobe Acrobat software allows publishers to make documents available on the World Wide Web that view and print identically as they were designed. This format is ideal for publishing forms and other documents that must be viewed and /or printed in the exact format as originally designed. Before you can view PDF files, you will need to download and install the Adobe Acrobat Reader Available free for a variety of computer platforms, from the Adobe Systems Incorporated WWW site.
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