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FAMIL Y PLANNING CLINIC - Pregnancy Testing Form Date ------------------- MENSTRUAL HISTORY First day of last menstrual period Was this a normal period Yes No Have you had Check all that apply Nausea Sleepy/Tiredness Was it Light Medium Increased Urination Breast Tenderness CONTRACEPTIVE HISTORY Are you currently using a birth control method Yes If you are currently using a birth control method what is it Have you...
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