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Get MD DHMH 4648 2009-2024

Rescription, OTC, vitamins, herbal) Last Normal Menstrual Period (LNMP) Last bleeding episode, if not LNMP Reason for requesting pregnancy test Positive urine pregnancy test: (check all that apply) EDC (by LMP) __________ Verification form given Options counseling Multivitamin with folic acid recommended Prenatal education Prenatal care recommended Refer for supportive services (WIC, MCHP, Healthy Start, DSS) Negative urine pregnancy test: (check all that apply) Repeat pregnancy test recommended.

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