Get What You Can Do About Des: Des Health Information Record - Cdc

This guide provides comprehensive instructions for completing the What You Can Do About DES: DES Health Information Record online. By following these steps, you can effectively manage your health decisions and communicate with your health care provider regarding DES exposure.

Follow the steps to fill out your DES Health Information Record.

1. Click the ‘Get Form’ button to obtain the DES Health Information Record and open it in your digital document editor.
2. Begin by filling out the general information section. Enter your full name, Social Security number, date of birth, blood type, primary health care provider's name, and any other specialists you are seeing. Also, provide your insurance carrier's name along with the policy/plan number, group number, effective date, and phone number.
3. In the DES health history section, indicate whether your mother was prescribed DES during her pregnancy with you. Check 'Yes,' 'No,' or 'Don’t know' as applicable.
4. Specify your relationship to someone who has been exposed to DES before birth. Similarly, indicate your status as a DES grandchild by checking the appropriate box.
5. Use the provided chart to track your health checkups. Record the dates of your recent physical exams, including any testicular exams (for men) or gynecological exams and mammograms (for women). There is space to document future exams as well.
6. Respond to the health conditions listed, providing information about any diagnoses you may have received, such as undescended testicles, urinary tract abnormalities, or any form of cancer. You can specify the type of cancer and the year of diagnosis.
7. In the notes section, you can include any additional comments or observations from your health care provider related to your DES exposure and health.
8. Upon completing all sections, review your entries for accuracy. Then, save the changes, download the completed form, or print it for your records. You may also choose to share it with your health care provider.

Complete your DES Health Information Record online today to take an important step in managing your health.