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C.

HISTORY:

1. Personal history

Living place:
Feeding:
Clothing:
Harmful habits:
Breeding animals:
Previous occupations:

2. Physiological history

Prenatal:
Natales:
Postnatal:
Menarche:
Date of last period:
First sexual relationship:
PAP
MAC
Dysmenorrhea
Leukorrhea
Psicomotriz development
Immunizations
Allergies

3. Pathological history

Previous hospitalizations:
Transfusions
Usual medication

4. Personal family history

Father Mother
Brothers Husband/wife
Sons

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