Data Field Information
| Prompt | Response | Req | Len |
|---|---|---|---|
| Pregnancy Indicator | If applicable, select this check box. | 
|
1 |
| Last Menstrual Period | Enter the date you want or click the calendar icon to select a date. |
10 |
|
| Estimated Due Date | Enter the date you want or click the calendar icon to select a date. | 10 |
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