Prenatal Health History Questionnaire, English (MNRS)

This comprehensive health history questionnaire will provide the doctor with the information necessary for effective management of the patient’s pregnancy. The first part of the questionnaire covers identification data, family illnesses, allergies, medication use, hospitalizations, and pregnancy history. The unique design of the comprehensive health history section allows only positive answers to appear on the physician’s copy, saving valuable time and quickly identifying risk factors or potential problems.

For physicians preferring to have the questionnaire completed at the patient’s home prior to the first visit, mailing envelopes (Stock No. 2360) are available.

Also available in Spanish (physician copy in English). See Stock No. 5851N.