Get Health Start Pregnancy History Screening Tool

This guide provides comprehensive instructions for completing the Health Start Pregnancy History Screening Tool online. By following these steps, users will be able to effectively provide needed information regarding their pregnancy history, enhancing their access to necessary health services.

Follow the steps to successfully complete the screening tool.

1. Use the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering your name and the date on which you complete the screening tool. This information is vital for your records.
3. Indicate your current pregnancy status by selecting from the choices provided: yes, no, don’t know, or declined to answer. If you are pregnant, you will be prompted to indicate how many weeks or months along you are.
4. Next, report the total number of times you have been pregnant, including any pregnancies that ended in live birth, miscarriage, stillbirth, abortion, or ectopic pregnancy.
5. If applicable, detail how each of your previous pregnancies concluded. Record the type of each pregnancy and the date it ended.
6. Answer if you have had any cesarean deliveries, followed by any complications experienced during past pregnancies.
7. Provide information on any babies born prematurely or weighing less than 5 pounds, 8 ounces at birth.
8. Indicate whether any of your children required hospitalization after your discharge.
9. Finally, clarify if all of your children are currently living with you.
10. Once you have completed all sections of the tool, you can save your changes, download, print, or share the form as necessary.

Complete the Health Start Pregnancy History Screening Tool online to help ensure you receive the support you need.