He encontrado que alguna farmacia puede tener existencias limitadas de ciertos medicamentos, mientras que otras pueden tener casi cualquier formato que se le ocurra y el habitual de dosis habitualidad apareció. En resumen, siempre se contiene el almacén de corroborar. Al mismo tiempo que el producto que más que gustaba ha resultado no estaba disponible en stock otro distinto por las Buenas costumbres también debe buscarse jefe no asн parezca. Por eso es importante disponer de un Plan B para actuar cuandod ello no ocurra. Ventaja de tomar un genérico en lugar de Asix Un genérico es más barato que el nombre de marca Uno de los mayores incentivos para someterse al Dónde comprar Lasix genérico en lugar de pagar la marca es que usted puede obtener un ahorrando importantes Lasix genérico. Por lo tanto, un Lasix genérico es en general mucho más barato que el homólogo de marca, así que una denominación genérica se hace posible para las personas que usan este medicamento con frecuencia. Un ejemplo: La compra de lurosemida en lugar de Lasix es una considerable ahorro para el presupuesto mensual de medicamentos.

Microsoft word - 443c324c-5921-28c8d6.doc

NORTH HOUSTON CENTER FOR REPRODUCTIVE MEDICINE
FEMALE PATIENT HISTORY
IDENTIFYING
INFORMATION Date____________________

Name_______________________________________________Partner’s Name_____________________________________________________
Address______________________________________________________________________________________________________________
Telephone: Home_______________________________Work________________________________Cell_______________________________
Date of Birth_________________Partner’s Date of Birth________________Duration of Relationship___________Duration of Infertility_________
Nature of present employment (Title, brief description)_________________________________________________________________________
II. MEDICAL
Weight__________Height__________Blood type (if known)___________________________________________________ YES NO Have you lost greater than 20 pounds of weight in the last year?…………………………………………………………………………… ! Do you fol ow a particular food diet or have any special dietary habits?……………………………………………………………………. ! If yes, specify:____________________________________________________________________________________________ List the form and frequency of regular vigorous exercise (swimming, cycling, running) and age you began: Exercise:_______________Hrs/Week__________Age__________ Exercise: _______________Hrs/Week__________Age_________ _ Have you ever had pelvic surgery? ……………………………………………………………………………………………………………… !
If yes, specify date and type: _____________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Do you have or have you ever had (check all that apply):
_____________________________ ! Ovarian Cysts ! Any medication Allergies? List: _____________________________________________________________________ ! Other Diagnoses: ________________________________________________________________________________ Have you ever-received X-rays to the pelvic area for therapy or diagnosis?………………………………………………………………. ! ! If yes, specify: _____________________________________________________________________________________________ List all current medications, both prescription and non prescription_____________________________________________________ _________________________________________________________________________________________________________ Do you use or have you ever used (check all that apply) ! Alcohol – How many servings per week do you usual y drink? _______________________________________________ ! Cigarettes – Number of packs per day _______________ Number of years ____________________________________ ! Marijuana, Cocaine, etc. ____________________________________________________________________________ III. MENSTRUAL AND PREGNANCY HISTORY Age at first period?________________ When did your last period begin? ________________________________________ Are your periods regular?…………………………………………………………………………………………………………………………. ! What is the usual number of days between periods?_______________________________________________________________ What is the usual duration of your period? ______________________________________________________________________ Are cramps: ! Mild ! Moderate ! Severe ! Absent Do you have to take pain medication for cramps? ……………………………………………………………………………………………. ! If yes, specify medication: ___________________________________________________________________________________ Do you bleed or spot between periods? ………………………………………………………………………………………………………… ! How many pregnancies (including abortions) have you had? _______________________________________________________ When?
Were there any complications during or after your pregnancies? ………………………………………………………………………………. ! !
If yes, explain: ______________________________________________________________________________________________
How long have you now been trying to get pregnant? _______________________________________________________________
Did your mother take diethylstilbestrol (DES) when she was pregnant with you? ………………………………………………………………
IV.
CONTRACEPTIVE / SEXUAL HISTORY
What form of contraception do you use now or have you used in the past? Check all that apply: ! Pills Name: ____________________ ! IUD Name: ____________________ ! Diaphragm ! Withdrawal ! Condom ! Other: ___________________________________________________________________________________________________ When did you discontinue contraception? (Approximate date) _____________________________________________________________ Is intercourse painful or difficult for you? …………………………………………………………………………………………………………………… ! ! Do you use lubricants for intercourse? ……………………………………………………………………………………………………………………. ! ! If yes, which one? ________________________________________________________________________________________________ V. FAMILY
Is there a family history of: (if yes, specify) ! Diabetes___________________________________________________________________________________________________ ! ! ! Birth Defects________________________________________________________________________________________________ ! ! ! Cancer____________________________________________________________________________________________________ ! ! ! Heart Disease / Strokes _______________________________________________________________________________________ ! ! ! Blood clots or bleeding problems_________________________________________________________________________________ ! ! ! Hepatitis or liver disease_______________________________________________________________________________________ ! ! ! Infertility____________________________________________________________________________________________________ ! ! ! Inherited or genetic diseases____________________________________________________________________________________ ! ! HISTORY OF FERTILITY THERAPY
Have you been treated for infertility before?…………………………………………………………………………………………………………………… ! ! If yes, who was your physician?________________________________________________________________________________________ What cause of infertility was diagnosed?_________________________________________________________________________________ What drugs have you taken for infertility? Check all that apply” ! Clomiphene citrate (Serophene, Clomid) ! Other – Specify_______________________________________ ! None Which of the following tests have you had performed? Check all that apply and the results if known: ! Postcoital Test? When____________________Results:____________________________________________________________ ! Hormonal Assays ? When____________________Results:____________________________________________________________ (FSH, LH, Prolactin, Estrogen, DHEA-S, testosterone, progesterone) ! Hysterosalpingogram? When______________________Results:________________________________________________________ ! Laparoscopy? When _________________________Results: ___________________________________________________________ ! Hysteroscopy? When____________________Results:_________________________________________________________________ ! Thyroid Tests ? When____________________Results:_________________________________________________________________ Have you ever had surgery for tubal reversal?……………………………………………………………………………………………………………. . ! ! If yes, specify dates________________________________________________________________________________________________ Have you ever had surgery for infertility?…………………………………………………………………………………………………………………… ! ! Have you ever had cervical conization, cryo or leep?……………………………………………………………………………………………………… ! ! Have you ever had any other surgery? ……………………………………………………………………………………………………………………. ! ! If yes, please specify:______________________________________________________________________________________________ Have you ever undergone artificial insemination or in vitro fertilization?………………………………………………………………………………. ! ! If yes, using partner or donor sperm?__________________________________________________________________________________ Is your partner seeing a doctor evaluation of infertility? …………………………………………………………………………………………………. ! ! If yes, specify physician name and location:_____________________________________________________________________________ Has he ever fathered a child with another woman?………………………………………………………………………………………………………. ! ! If yes, when? ____________________________________________________________________________________________________

Source: http://www.nhcrm.com/female-patient-history-form.pdf