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NEW PATIENT HISTORY - UC Health

NEW PATIENT HISTORY - UC Health 2026

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The document is a Female Patient History Form from the UC Center for Reproductive Health, designed to collect comprehensive medical and reproductive history from female patients seeking assistance with conception. It includes sections on identifying information, pregnancy history, contraceptive use, surgeries, medical history, allergies, menstrual and gynecologic health, sexual history, family and genetic history, and previous fertility treatments. The form aims to gather detailed information to facilitate effective treatment and support for patients experiencing infertility.

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Click ‘Get Form’ to open the NEW PATIENT HISTORY - UC Health in the editor.
Begin by filling out the IDENTIFYING INFORMATION section. Enter your name, date of birth, and age. Include your significant other's details if applicable, and select your primary language.
In the PREGNANCY HISTORY section, provide details about all pregnancies, including full-term births and miscarriages. Use the provided fields to document each pregnancy's specifics.
Complete the CONTRACEPTIVE USE section by listing types of contraception used, duration, and reasons for discontinuation.
Proceed to SURGERIES AND HOSPITALIZATIONS. Fill in dates and reasons for any surgeries you have had.
In the MEDICAL HISTORY section, check any conditions you have or have had. Be thorough in documenting any additional medical problems not listed.
Continue through ALLERGIES, MENSTRUAL/HORMONAL history, GYNECOLOGIC/INFECTION history, and SEXUAL HISTORY sections as prompted.
Finally, review FAMILY HISTORY/GENETIC HISTORY and HISTORY OF FERTILITY THERAPY sections carefully before submitting your form.

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Versions	Form popularity	Fillable & printable
2023	4.3 Satisfied (27 Votes)
2023	4.1 Satisfied (45 Votes)
2023	4.1 Satisfied (46 Votes)
2022	4.8 Satisfied (52 Votes)
2021	4.8 Satisfied (61 Votes)
2021	4.8 Satisfied (31 Votes)
2021	4.7 Satisfied (124 Votes)
2021	4.8 Satisfied (145 Votes)
2021	4.8 Satisfied (89 Votes)
2021	4.8 Satisfied (49 Votes)
2021	4.5 Satisfied (36 Votes)
2021	4.2 Satisfied (40 Votes)
2020	4.2 Satisfied (46 Votes)
2020	4.5 Satisfied (50 Votes)
2020	4.8 Satisfied (39 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is there a universal health record?

FollowMyHealth (FMH) is referred to as a Universal Health Record, designed to offer you seamless access to your medical records anytime and anywhere you have an internet connection.

What charting system does UC health use?

Epic is a fully integrated, CMS-certified electronic medical record (EMR) system and is the most widely used EMR in the US.

What EHR does UCLA health use?

Log into Cornerstone You are required to complete the CareConnect training in Cornerstone, UCLA Healths learning management system (LMS). CareConnect is UCLAs electronic health record (EHR) program.

What is the most commonly used EMR system?

CLEVELAND University Hospitals (UH) completed the transition to the Epic electronic health record (EHR) over the weekend.

How to update medical history?

If information in your GP health record is incorrect, contact your GP surgery. They can update personal information in your record, such as your address. Contact your GP surgery if something is missing from your GP health record. It may be missing because you do not have access to all the information in your record.