PATIENT #17
Tan, Rashid Ali Payapat
Registered 2026-09-10 03:47:46
Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, Rosary Heights 7, Cotabato City, 9600
Tel: (064) 552-0086, 421-3988 Fax: (064) 421-6842
Personal Details and Consent
Last name
Tan
First name
Rashid Ali
Middle name
Payapat
Region
BARMM
Province
Maguindanao Del Norte
Municipality
SULTAN KUDARAT (NULING)
Barangay
Crossing Simuay
Date of birth
1996-02-02
No. of children
1
Civil status
Married
Name of health facility
MOH Clinic
Other procedure(s)
Not recorded
Age
30
Gender
Female
Consent acknowledgment
Acknowledged
Procedures
VIA, HPV DNA testing
History Taking
First menstrual period (menarche)
1
Last menstrual period (LMP)
2026-09-10
Age of gestation (AOG), if applicable
16
Menstrual bleeding pattern
Irregular
No. of pads per day
3
Gravida (no. of pregnancies)
1
Parity (no. of deliveries)
1
No. of full-term deliveries
1
No. of pre-term deliveries
0
No. of abortions
0
No. of living children
1
Age at first full-term pregnancy
16
Oral contraceptives duration (previous and current): no. of years
1
Oral contraceptives duration: no. of months
1
History of previous cervical cancer screening
No
History of previous breast cancer early detection
No
History of abnormal vaginal discharge
No
History of abnormal vaginal bleeding
No
Age at first intercourse
14
No. of sexual partners
1
Spouse / partner(s)
Not applicable
STI history — client
Not applicable
STI history — spouse / partner
Not applicable
Family history of cancer
Not applicable
Smoking
No
Current medication
No
Allergies
No
Abdominal surgery
No
III. Physical Examination - Vital Signs and Anthropometric Measurements
Blood pressure (mmHg)
120/78
Temperature (°C)
36
Heart rate (beats/min)
90
Respiratory rate (breaths/min)
90
Height (cm)
178
Weight (kg)
64
BMI (kg/m²)
20.2
Skin and HEENT
Skin: Pallor
Absent
Skin: Rashes
Absent
Skin: Jaundice
Absent
HEENT: Anicteric sclerae
Absent
HEENT: Aural discharge
Absent
HEENT: Nasal discharge
Absent
Neck findings
none
Chest, Heart and Abdomen - For Doctors / Trained Health Care Providers
Chest and lungs: Clear breath sounds
Absent
Chest and lungs: Crackles / rales
Absent
Chest and lungs: Wheezes
Absent
Heart: Normal rate
Absent
Heart: Regular rhythm
Absent
Heart: Murmur
Absent
Abdomen: Scars
Absent
Abdomen: Stretch marks
Absent
Abdomen: Presence of mass
Absent
Abdomen: Enlarged liver
Absent
Abdomen: Tenderness
Absent
Abdomen: Presence of fluid wave
Absent
Breast Examination
Breast findings: Mass
Absent
Breast findings: Nipple discharge
Absent
Breast findings: Skin-orange peel or dimpling
Absent
Breast findings: Enlarged axillary lymph nodes
Absent
Right breast
none
Left breast
none
Pelvic Examination
Vulva: Redness (inflammation)
Absent
Vulva: Tenderness
Absent
Vulva: Ulcers
Absent
Vulva: Blisters
Absent
Vulva: Warts
Absent
Vulva: Cyst
Absent
Vulva: Skin tags
Absent
Other vulvar mass - specify
normal
Bartholin’s and Skene’s glands: Swelling
Absent
Bartholin’s and Skene’s glands: Tenderness
Absent
Bartholin’s and Skene’s glands: Discharge
Absent
Speculum exam: Vaginal or cervical lesion
Absent
Speculum exam: Tears
Absent
Speculum exam: Ulcers
Absent
Other speculum abnormalities
normal
Pelvic Examination - For Doctors / Trained Health Care Providers
Bimanual exam - size
normal
Bimanual exam - shape
normal
Position of uterus
normal
Bimanual findings: Cervical motion tenderness
Absent
Bimanual findings: Adnexal masses or tenderness
Absent
Recto-vaginal exam (if the bimanual is confusing)
none
IV. Screening Results
VIA findings
nond
VIA result
Suspect cancer
Pap smear / HPV DNA results
none
V. Counselling Given
Counselling given
none
VI. Treatment and Other Care Given
Treatment and other care given
none
VII. Referral
Referral notes
none
Printed name of health care provider
Michelle Lu
VIA Screening Result
VIA result
Suspect cancer
Examined by
Michelle Lu
Examination date
2026-09-10
Remarks
None