年月日周期12345678910111213141516171819202122232425262728293031323334353637383940体温37.137.036.936.836.736.636.536.436.336.236.136.0备注年月日周期12345678910111213141516171819202122232425262728293031323334353637383940体温37.137.036.936.836.736.636.536.436.336.236.136.0备注年月日周期12345678910111213141516171819202122232425262728293031323334353637383940体温37.137.036.936.836.736.636.536.436.336.236.136.0备注①、•表示体温 ②、☉表示是日有性生活，注明时间 ③、×表示经期，量少时“、” ④、↑表示症状检查及治疗开始 ⑤、↓表示停止治疗或停药姓名______________ 病案号____________________________诊断______________________________________________________________________月经周期___________________________子宫内膜_____________________________________________________________________________________________________