Eligible participant has to fullfill all of the following items

Anyone with one of following items or more should be excluded:

Date of signing the informed consent

Date of birth

yyyy-mm-dd

Age

Years

Education background

Occupation

Other (Description)

小时

Number of pregnancy

次

Number of delivery

次

If has delivery history, select following items

partus maturus

次

premature delivery

次

abortion

次

Last pregnancy

yyyy-mm-dd

Average times of menstrual onset a year

次/年

Average menstrual cycle

天(days)

Menarche time

岁(years)

The time of last Menstruation

年、月、日(yyyy-mm-dd)

The time of menstrual onset before the last one

年、月、日(yyyy-mm-dd)

年/月/日（yyyy-mm-dd）

Namy of the drug to be allergied

Vulva

Description in detail for abnormal

Vagina

Description in detail for abnormal

Uterine neck

Description in detail for abnormal

Corpus uteri

Description in detail for abnormal

Adnexa uteri

Left side

Description in detail for abnormal

Right side

Description in detail for abnormal

Weight

kg

Hight

mm

Systolic pressure (SP)

mmHg

Diastolic pressure

mmHg

Temperature

degree Celsius

Pulse rate

次/分

Breath frequency

次/分

Doctor signature

Date

yyyy-mm-dd

WBC

×109 /L

NEUT%

%

LY%

%

MONO％

％

RBC

×10^12 /L

HGB

g/L

PLT

×10^9 /L

Researcher signature

Date

yyyy-mm-dd

Acidity and allkalinity

pH value

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

UBG

NIT

Date of test

yyyy-mm-dd

Date of test

yyyy-mm-dd

K

mmol/L

Na

mmol/L

Cl

mmol/L

Ca

mmol/L

P

mmol/L

Date of examination

yyyy-mm-dd

Prothrombin time

秒

Thrombin time (TT)

秒

Activated partial thromboplastin time (APTT)

秒

Fibrinogen (FIB)

g/L

ALT

IU/L

AST

IU/L

GGT

U/L

Serum bilirubin

μmol/L

Indirect bilirubin

umol/L

Direct bilirubin

umol/L

Serum albumin

g/L

Serum globulin

g/L

Serum total protein

g/L

Date of test

yyyy-mm-dd

Date of test

yyyy-mm-dd

Date of test

yyyy-mm-dd

Date of test

yyyy-mm-dd

Date of test

yyyy-mm-dd

SCr

μmol/L

Blood urea

mmol/L

Blood uric acid

μmol/L

Date of test

yyyy-mm-dd

D-dimer value

ug/mL

Date of test

Urine pregnancy test

Blood HCG concentration

mIU/mL

Date of test

yyyy-mm-dd

Size of the ulcer

cm*cm

Uterine echo distribution

Endometrial thickness

mm

Left ovary size

cm ×cm

Shape of Left ovary

Size of the Ovarian cyst

Right ovary size

cm ×cm

Shape of right ovary

Size of Ovarian cyst

Description of other abnormal findings

Diagnosis of the Ultrasound B

Doctor signature

Date of examination

yyyy-mm-dd

Pain Visual Analogue Score

PH

PCO2

mmHg

P02

mmHg

SO2

％

HCO3

mmol/l

SBE

mmol/l

LAC

mmol/L

Date of examination

(yyyy-mm-dd)

右卵巢

3 cm

无 °

刘义彬

2024-1-26

D-dimer value

0.35 ug/mL

Date of test

2024-1-27

Body temperature

36.4 ℃

Systolic pressure (SP)

135 mmHg

Diastolic pressure (DP)

84 mmHg

Heart Rate, HR

84 次/分

Pulse

36.4 次/秒

WBC

10.00 ×109 /L

NEUT%

77.82 %

LY%

16.18 %

MONO％

5.47 ％

RBC

3.83 ×10^12 /L

HGB

104 g/L

PLT

288 ×10^9 /L

Date

2024-1-27 yyyy-mm-dd

Pain Visual Analogue Score