Pregnant

Select this check box if the person is currently pregnant.

Approximate Due Date

Enter the date when the child is due. Use the format MM/DD/YYYY.

Previous Pregnancies

Select this check box if the person has been pregnant in the past.

# of Pregnancies

Enter the number of times this person has been pregnant.

# of Children Alive

Enter the number of children.

# of Miscarriages

Enter the number of miscarriages and elective abortions.