The patient declares that the above-mentioned drug has been prescribed to her by a gynecologist or family doctor and is using it chronically.
The patient states that no disturbing symptoms occurred during its use.
The patient declares that she is not pregnant.
The patient declares that she did not suffer from:
No neoplastic disease, thrombophlebitis, venous thromboembolism, cerebrovascular disease – stroke, transient ischemic attack, unexplained pathological bleeding from the genital tract, breast cancer or cancer of the genital organs, nor is it under diagnosis, diabetes with complications vascular disease, migraine, liver disease, coronary obstruction – coronary artery disease, heart attack
The patient declares that she occasionally controls arterial pressure and its values do not exceed 140/90
The patient declares that I do not know the congenital or acquired predisposition to venous thromboembolism (e.g. resistance to active protein C [including factor V Leiden], antithrombin III deficiency, protein C deficiency, protein S deficiency)
The patient declares that she doesn’t take antiretroviral (HIV) drugs
The patient declares that she is 18 years old and that she is acting on my behalf. All data is true and true to her health. The patient is extending the prescriptions for her chronic medications because she does not have access to her attending physician and her medications have run out. It acts on her own behalf, and it only needs drugs for herself. She is aware that by misleading a doctor it may lead to negative consequences for her health and even life. Is aware that a medical consultation takes place only to obtain a prescription for drugs taken on a permanent basis and does not replace a personal medical examination.