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Get Highland OB/GYN Patient Medical History Form 2012-2021

R (specify) ______________ ________ Or None □ Year PAP SMEAR / MAMMOGRAM HISTORY Date of last PAP smear: _____________________ Date of last Annual Wellness Exam: __________ Have you ever had an abnormal pap smear? Yes □ No □ Have you ever had treatment for an abnormal pap smear? Yes □ No □ If yes, what type(s) of treatment have you had? Check all that apply: Or None □ Cryotherapy Yes □ No □ Cone biopsy Yes □ No □ Colposcopy Yes □ No □ Loop excision (LEEP) Yes □ No □.

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