Obstetrician & Gynaecologist Template

Colposcopy

A professional Obstetrician & Gynaecologist template for healthcare professionals.

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Specialty

Obstetrician & Gynaecologist

Used

20 times

Type

Note

Last edited

23/10/2025

Created by

Pranali Patel

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About this template

Need a streamlined way to document colposcopy procedures? This Colposcopy template is designed for Obstetricians and Gynaecologists. It helps you create detailed and accurate clinical notes, covering patient history, examination findings, and treatment plans. This template is perfect for capturing all the essential information needed for effective patient care. With Heidi, this template can be quickly populated from your visit transcript, saving you time and improving documentation accuracy.

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32 G2P1 **Cervical Screening History To Date** - 03/03/2018: HPV negative, LBC negative, endocervical component present. - 15/06/2021: HPV positive, LBC: ASCUS, endocervical component present. - 10/09/2024: HPV positive, LBC: HSIL, endocervical component present. **Current Symptoms:** The patient reports experiencing intermittent post-coital bleeding for the past three months. She denies any other current symptoms. **Gynaecological and Obstetric History** - Menarche at age 13. - Regular menstrual cycles, lasting 5 days, with moderate flow. - No history of sexually transmitted infections. - No previous gynecological surgeries. - One full-term vaginal delivery in 2019. - One miscarriage in 2023. The patient is a non-smoker. The patient received three doses of Gardasil in 2010. Parous, with one viable pregnancy. The patient is not immunocompromised. Post-coital bleeding is present. Intermenstrual bleeding is absent. The patient is currently using an intrauterine device (IUD) inserted in 2020. **PMSHx** - Asthma - Salbutamol inhaler as needed. - No known allergies. - Mother: history of cervical cancer. - Non-smoker, occasional alcohol use, works as a teacher, lives with partner, feels safe at home. **Colposcopy Examination:** Cervix shows AWE in the transformation zone, with a mosaic pattern. LBC was performed, showing HSIL. STI swabs were not taken. Vaginal swabs were not taken. Biopsies were taken from the 3, 6, and 9 o'clock positions. **Impression** HSIL. **Plan** The patient will be scheduled for a Loop Electrosurgical Excision Procedure (LEEP) in four weeks. The patient was counselled on the procedure and potential risks. The patient was advised to abstain from sexual intercourse for two weeks after the LEEP procedure. The patient was also advised to return for a follow-up appointment in six months for repeat cervical screening. The patient was provided with educational materials on cervical cancer and HPV.