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Female Medical History
Women's health
Women's health consultation

What is a woman?
A female person more than 18 years old.
Women is plural of woman.
A woman has to be distinguished from a man, a child, or an adolescent girl.

What should a women know relevant to doctor’s consultation?
Human pregnancy is not the only issue that a woman brings to a doctor. Women can have many other issues.

What is women's health?
Women's health refers to health issues specific to human female anatomy.

How has women health consultation been elaborated?
Health issues relevant to her pregnancy now.
Health issues relevant to her previous pregnancy.
Health issues not relevant to her pregnancy.

What should I know about you?
Address
Activities of everyday living
Annual health assessment
Assets
Abilities/skills
Communications
Complaint/problem
Contraception History
Duties
Detention
Education
Emergency Contact
Family Medical History
Hospitalization
Impairment Rating and Disability Determination
Language
Menstrual History
Pregnancy History (if you have not ever been pregnant, skip to the next section)
Photograph
Profession
Personality questions
Referrals
Survival Needs
Stress
Social History
Sexual History
Travel history

How should you answer these questions?
Answer to the best of your ability and knowledge.

What should you write if a question is not applicable to you?
This is not applicable to me at this point.

Questions relevant to female medical history
Take a look at this.
Questions you need to answer.

Question 2

What is your name?

Question 3

What is your date of birth?

Question 4

What languages can you understand?

Question 5

What is your telephone number?

Question 6

Where is the patient now?

Question 7

How old is the patient?

Question 8

What is the gender of the patient?

Question 9

What are the sources of medical history?

Question 10

What best describes the patient?:

Question 11

In general, how is your physical and mental health?

Question 12

Do you have any appointments scheduled with doctors or other specialists?

Yes
No

Question 13

Have you been in the hospital in the last month?

Yes
No

Question 14

Do you have health problems that you need help with right away?

Yes
No

Question 15

Do you need extra help to access services, such as a wheelchair ramp, a computer screen reader or large print materials?

Yes
No

Question 16

Screening for survival needs

Do you have enough of these resources from the state?
Food
Clothing
Housing
Health care
Transportation
Security
Education
Consumer goods
Communication

Do you need any of these resources to be enhanced?

Question 17

Are you currently breastfeeding?

Question 18

Is your complete medical history ready?

Yes
No

Question 19

Primary Care Physician Name, Address and Phone:__________________

Emergency Contact Name:______________

Relationship:________________________

Question 20

Your Height:_________________________

Your Weight:_________________________

Question 21

Referred by:_________________________

Question 22

What seems to be the problem?

Question 23

What is the reason for consultation?

Question 24

What best describes problem of the patient?
Sleep problems.
Anger.
Relationship problem.
Not taking care of self.
Not taking care of others.
Misinterpreting the facts.
Recent social withdrawal or loss of interest in others.
Illogical thinking typical of childhood but in an adult.
Repeatedly checking or doing activities that seem abnormal.
Restlessness.
Administrative abuse/harms from others.
Thoughts or threats to hurt oneself or others.
Social withdrawal after death of a person known to the patient.
Communication problem (speech, writing, reading, expression).
Not enough food, clothing, housing needs, transportation, health care, or education.
Other issues.
You need to give details of the issues or problems.

Life-threatening conditions.

Suicidal thoughts.
Homicidal thoughts.
Assault, violent actions or behavior.
Delirium or extreme agitation.
Feeling that harms have been inflicted or are being inflicted, and that harms are going to be inflicted that need to be prevented.

Question 25

Is the claim any one of these?
Psychological torture
Physical torture
Corruption in politics of regulations
Racism
Deprivations of rights under the color of law
Political abuse
Discrimination
Disruption
Exclusion

Question 26

Did anyone beat or torture you at any point since birth?

Question 27

Is there any incident or issue in past, present, or future that is causing distress to you?

Question 28

Did you experience any one of these that has troubled you since the day you were born?

Assault.
Accidents.
Child abuse or captivity.
Childbirth.
Death of a loved one.
Fire.
Rape.
Natural disaster (hurricanes, earthquakes, tsunamis).
Road traffic crash.
Building collapse.
Fire.
Shooting.
Neglect of a child leading to a serious harms.
Domestic violence.
War.
Genocide.
Torture.

If yes, what are the details?

If any other traumatic, stressful, harmful, or horrifying event, give more details.

Question 29

What conditions require emergency psychiatry consultation?
1. Attempted suicide.
2. Attempted homicide.
3. Substance abuse. v 4. Psychosis(delusions, hallucinations, catatonia, thought disorder, loss of contact with reality).
5. Suicidal thoughts, homicidal thoughts.
6. Violence or other rapid changes in behavior.
7. Abuse.
8. Environmental factors (hostile environment).
9. Functional impairment (not taking care of self. inability to gain relevant skills and knowledge relevant to age).
10. Personality disorders (harmful to others).
11. Panic attacks.
12. Loosening of social inhibitions.
13. Likely to be harmful to self or others.
14. Serious drug reactions with psychiatric or non-psychiatric medications.
15. Intentional enforced harms.
16. Other.
Here are further guidelines.

What best describes you?

Question 30

Is the individual on any medication?

Question 31

Intentional enforced harms

What are intentional enforced harms?

Question 32

Commons Signs and Symptoms of Major Mental Illnesses
Anxiety
Bi-Polar Disorder
Chemical Dependency
Depression
Psychotic Disorders

Take a look at this.
What best describes you?

Aggressive
Anger
Anxiety
Avoidance of situations
Being unable to limit the amount of alcohol you drink
Blunted
Building a tolerance so that you need an increasing number of drinks to feel the effects
Carelessness about personal grooming
Change in appetite
Changed sleeping pattern
Changes in Behavior – Sleep disturbance
Changes in Emotion and Motivation
Changes in Thinking and Perception
Chest pain
Choking
Chronic fatigue, lack of energy
Confusion
Constipation
Crying spells
Decrease concentration and memory
Decreased appetite
Decreased coordination
Delusions
Depression
Depression as the drug wears off
Diarrhea, muscle aches
Difficulties with concentration or attention
Difficulty concentrating
Distress in social situations
Dizziness
Drinking alone or in secret
Drowsiness
Dry mouth
Elated mood
Especially if alcohol isn't available
Euphoria
Experiencing physical withdrawal symptoms such as nausea, sweating and shaking
Feeling a need or compulsion to drink
Feeling that self or others have changed or are acting different in some way
Flashbacks, a re-experience of the hallucinations — even years later
Flat or inappropriate emotion
Flushing
Frequent self-criticism
Grandiose delusions
Greatly impaired perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors guilt
Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel "normal"
Hallucinations
Having legal problems
Having problems with relationships
Headache, sweating
Heart palpitations
Helplessness
High blood pressure
Hopelessness
Hyperventilation
Impaired memory and concentration
Impaired motor function
Impatience
Increased appetite
Increased blood pressure and heart rate
Increased energy and overactivity
Increased heart rate
Increased heart rate, blood pressure and temperature
Indecisiveness and confusion
Indecisiveness, irritability
Insomnia
Irregular menstrual cycle
Irritability
Irritability when your usual drinking time nears
Keeping alcohol in unlikely places at home
Lack of coordination
Lack of emotional responsiveness
Lack of energy, overeating or loss of appetite
Lack of inhibitions
Lack of insight.
Losing interest in activities and hobbies that used to bring pleasure
Loss of appetite
Loss of interest in hobbies, sports, and other favorite activities
Loss of interest in personal appearance(Social grooming)
Loss of memory
Loss of motivation, chronic fatigue
Loss of motivation, drug or alcohol use
Loss of sexual desire
Making a ritual of having drinks before, with or after dinner and becoming annoyed when this ritual is disturbed or questioned
Memory impairment
Mind racing or going blank
Mood swings
Nasal congestion and damage to the mucous membrane of the nose in users who Snort drugs
Nausea and vomiting
Nausea, vomiting
Needing less sleep than usual
Needle marks (if injecting drugs)
Neglect of responsibilities
Not remembering conversations or commitments, sometimes referred to as blacking out
Numbness
Obsessive or compulsive behavior
Overeating or loss of appetite
Panic
Paranoia
Paranoid thinking
Permanent mental changes in perception
Phobic behavior
Poor memory
Rapid heartbeat
Rapid speech
Rapid thinking and speech
Red eyes
Red or glassy eyes
Reduced ability to carry out work or other roles.
Reduced energy and motivation
Reduced sense of pain
Restlessness
Restlessness or feeling “on edge” or nervousness
Runny nose
Sadness
Sedation
Self-blame, pessimism
Self-criticism, self-blame, pessimism
Sense of alteration of self
Sensory Changes(A heightened sense of visual, auditory and taste perception. A reduction or greater intensity of smell, sound or color)
Shortness of breath
Sleep disturbance
sleeping too much or too little
Slowed breathing
Slowed breathing and decreased blood pressure
Slowed reaction time
Slurred speech
Social isolation or withdrawal
Strange ideas
Sudden change in behavior
Sudden mood swings
Suspiciousness
Tendency to believe others see you in a negative light
Thoughts of death and suicide
Tingling and numbness
Tiredness
Tremors
Tremors/shaking
Unexplained aches and pains
Unrealistic and/or excessive fear and worry
Unusual perceptual experiences
Violent Behavior
Vivid dreams
Weight loss
Weight loss or gain
Withdrawal from family members and/or long-term friends
Withdrawal from others
Worrying

Question 33

What is the date you are documenting these facts?

Question 34

What is troubling you?

Question 35

Address

What is your mailing address?

________________________

________________________

________________________

________________________

Question 36

Where are you located now?

Question 37

What was your mailing address from birth until now?
_________________________

_________________________

_________________________

_________________________

Question 38

Where do you live now?

Question 39

How long have you lived at this address?

Question 40

What is your contact information including current mailing address, telephone, e-mail, and any other details, and person to contact in case of emergency?

Question 41

How long do you plan to live at this address?

Question 42

Abilities/skills

What are your abilities and skills?

Question 43

Annual health assessment

When was your last annual health assessment done?

Question 44

Who did your last annual health assessment?

Question 45

What were the findings?

Question 46

What were the recommendations?

Question 47

Did the recommendations help?

Question 48

Was it an annual health assessment or evaluation of a new problem?

Question 49

When did you last see a medical doctor?

Question 50

Did you see a medical doctor for an annual health assessment or a new problem?

Question 51

What seemed to be the problem?

Question 52

What was the diagnosis and treatment?

Question 53

What is the name and contact information of the medical doctor who gave you this diagnosis and treatment?

Question 54

Communications

What is the best method to communicate with you?
E-mail.
Fax.
Telephone call.
Postal mail.
Communication through media.

Question 55

Complaint/problem

Do you have any complaint/problem relevant to human health care today?

Question 56

If you have any complaint/problem relevant to human health care today, what are the details?

Question 57

What is your complaint or problem relevant to being a woman?
Activities of everyday living issues
Annual health assessment issues
Assets issues
Abilities/skills issues
Contraception issues
Communications issues
Duties
Detention issues
Education issues
Emergency contact details issues
Family issues
Hospitalization issues
Impairment rating and disability determination
Language issues
Menstruation issues
Pregnancy issues
Profession issues
Personality questions
Referrals issues
Relationships issues
Survival needs issues
Stress issues
Social issues
Sexual issues
Signs of genital or breast lumps, discharge, or sores.
Issues not specified above

Question 58

Do you think there are any other issues relevant to woman?

Question 59

What are the details of the issue or issues?

Question 60

How are you feeling today?

Question 61

Do you have any problems today?

Question 62

What seems to be the problem?

Question 63

Do you have any other problems?

Question 64

Can you explain?

Question 65

Who raised you from birth until you were 18 years old?
Biological mother
Biological father
Foster mother
Foster father
Medicolegal case

Question 66

What values were you raised with at home?

Question 67

What values were you raised with in school?

Question 68

What values were you raised with in the community?
_________________________

Religious values, liberal sexploration values.
Honesty, compassion, integrity, forgiveness, love, knowledge, discipline, faith, and leadership (positive values).
Prejudice, hatred, greed, selfishness (negative values).

Question 69

Emergency contact

You need to mention at least one woman to contact in case of emergency, and one more in case this woman is not available.

What is the name, date of birth, contact details, including current mailing address, telephone, e-mail, and profile of an individual or individuals who should be contacted in case of emergency relevant to you?

Question 70

How is this individual related to you?

Question 71

Do you need a good charactered, well behaved, competent legal guardian?

Question 72

When was your last menstrual period?

Question 73

Are you in a sexual relationship now?

Question 74

Have you ever been a victim of a physical or sexual assault?

Question 75

Have you been in a relationship which involved hitting, slapping, kicking or other physical abuse?

Question 76

Has anyone forced you to have sexual activities?

Question 77

What surgeries have you had?

Question 78

Do you have any past or present medical or mental health problems that require a doctor’s care?

Question 79

Do you experience pain with intercourse?

Question 80

Do you experience bleeding after intercourse?

Question 81

Do you experience pain between periods?

Question 82

Are you currently experiencing vaginal discharge?

Question 83

Are you currently experiencing vaginal itching or discomfort?

Question 84

Have you experienced prolapse of bladder uterus or bowel?

Question 85

Have you experienced leakage from bladder or bowel?

Question 86

Who currently lives in household?

Question 87

Do you regularly exercise?

Question 88

Have you ever had a sexually-transmitted disease?

Question 89

Do you smoke cigarettes?

Question 90

Have you ever smoked cigarettes?

Question 91

Do you use other tobacco products?

Question 92

Do you drink alcohol?

Question 93

Have you ever been physically abused or hurt?

Question 94

Have you ever been forced to have sexual activity?

Question 95

Are there firearms in your home?

Question 96

Do you have any medical problems or additional concerns not mentioned above?

Question 97

Impairment Rating and Disability Determination
Health status

How would you describe your health status relevant to your age?
100% mentally fit.
100% physically fit.

Question 98

Do you have any problems with activities mentioned below relevant to your age?

Walking
Seeing
Hearing
Speaking
Breathing
Learning
Working
Caring for oneself (eating, dressing, toileting, etc.)
Performing manual tasks
Getting started after sleep
Sitting
Sleeping

Question 99

Menstrual history

What was the first day of your last menstrual period? (dd/mm/yy) Don’t know

Question 100

Are you sure of that date? Yes No N/A

Question 101

How many days does your period last? days

Question 102

How many days are there between your periods? days

Question 103

Are your periods regular? Yes No N/A

Question 104

Pregnancy history

How many times have you been pregnant in total (including this one)?

Question 105

Deliveries

Year	Length of pregnancy (weeks or months)	Delivery type(Vaginal C-section)	Problems (if any)	Location
_________	_________	_________	_________	_________
_________	_________	_________	_________	_________
_________	_________	_________	_________	_________
_________	_________	_________	_________	_________
_________	_________	_________	_________	_________

Question 106

Miscarriage, abortion, and ectopic

Year	Length of pregnancy (weeks or months)	Miscarriage	Abortion	Ectopic	Problems (if any)	Location
_________	_________	_________	_________	_________	_________	_________
_________	_________	_________	_________	_________	_________	_________
_________	_________	_________	_________	_________	_________	_________
_________	_________	_________	_________	_________	_________	_________
_________	_________	_________	_________	_________	_________	_________

Question 107

Have you had an ultrasound scan during your current pregnancy?

_________________________

Yes No

If yes, please bring copy to your appointment

Question 108

Have you had any pain during your current pregnancy?

Question 109

Have you had any bleeding during your current pregnancy?

Question 110

Have you had any nausea or vomiting during your current pregnancy?

Question 111

What are the issues?

Question 112

Who is writing answers to these questions?
The patient.
Someone else on behalf of patient.

If someone else is answering these questions on behalf of the patient, how are you related to the patient?
Sister
Cousin
Brother
Mother
Father
Case manager
Relative
Primary care physician
Nurse
If other, specify.

Question 113

Harms/abuse screening

What best describes harms/abuse on you?
Harmed by an individual living in the household.
Harmed by an individual living in the same building or house.
Harmed by an individual living within walking distance.
Harmed on the way.
Harmed at workplace.
Harmed by others.

Question 114

Can you elaborate on the harms/abuses?

Question 115

What is the profile and location of the individual or individuals involved in harms?

Question 116

How should you elaborate on the harms/abuses?
Day/date/location/individual or individuals involved.
Continuous harms (this also can include survival needs).

I have read and agree to the Terms & Conditions.

Are you ready to get started, or do you have other questions about the Internet consultation?

Have you read the facts about the services you are getting?
Everything is displayed publicly.
There is no hidden agenda.
There is no professional damages for these services through www.qureshiuniversity due to the fact that everything is displayed publicly for scrutiny by any professional.
If any individual or professional feels any professional abilities need to be added, he or she can forward recommendations.

Where are you in the process?

I am trying to get information about the services via the Internet: how it works, whether it is right for me.
I have decided to get consultation, recommendations; I need to set up remuneration issues.
I have decided to get consultation and am in the process of answering questions.
I have a question about online questions and consultation. Other.
I have read and agree to the Terms & Conditions.

These are basic questions.
There are many more.

Once the above listed relevant questions about comprehensive patient assessment are answered and received, you will get another questions list relevant to age, gender, location, problems, or issues, if any.

This will be followed by specific recommendations.

These are basic questions.
There are many more.

Once you reply to these questions, you will get questions relevant to your issues with recommendations. How should you communicate with your medical doctor? Last Updated: March 19, 2014