Well-Woman Screening - Annual Checklist

Last Pap (Date/Result): \nHistory of Abnormal Pap: \nLast mammogram (date/Result): \nHistory of Abnormal Mammogram : \nLast Colon Cancer Screen: \nLast Bone Density Screen: \nDiabetes Screen: w/PCP\nThyroid Screen: w/PCP\nLipid Screen: w/ PCP\nVitamin D Screen: w/ PCP\nAnemia Screen: w/ PCP\nSTI screenL Declines\n\nDepression: Low Risk\nViolence: Endorses Safety\nGuns: \nVaccines: Up to date\nSeat Belt Use: Every time\nFamily Planning: