In honor of National Women’s Health Week, da Vinci Surgery, Everyday Health, The Office on Women’s Health, and hundreds of hospitals across the U.S. have teamed up to bring you “Women’sWorks: Tools for a Healthier You.” These wellness events, led by doctors in your community, aim to educate women 35 and older about early detection and treatment options for common health issues.

About the Partners da Vinci® Surgery is the product of the global leader in minimally invasive robotic-assisted surgery. A growing number of doctors use da Vinci Surgery to treat a wide range of benign and cancerous conditions. It is the #1 surgical option for gynecologic cancer and prostate cancer. Thousands of trained surgeons are now able to offer this minimally invasive option to their patients.

The Office on Women’s Health (OWH), a Division of the U.S. Department of Health and Human Services, created womenshealth.gov, the federal government source for women’s health information. Womenshealth.gov is regarded as one of the most credible health sites worldwide. OWH also established National Women’s Health Week, a weeklong observance every May aimed at empowering women to make their health a top priority and encouraging them to take steps to improve their physical and mental health and lower their risks for disease.

Everyday Health is currently the largest online health destination on the web attracting more than 27 million unique monthly visitors and the greatest number of women aged 35-54 in the online health category (Source: comScore Media Metrix, 10/2010). The site helps consumers manage their own and their family’s health and overall well-being through personalized advice, tools, and communities.

Women’sWorks: Tools For A Healthier You Is your body looking, feeling, and acting differently than it did just a few years ago? If you’re over 35, it probably is.

Track your symptoms, healthcare appointments, treatments, test results and much more. Please use this diary as an on-going tracking tool and bring it to all of your healthcare appointments. Remember to schedule your annual doctor’s appointments, take action on your medical issues, ask questions and always get a second opinion about important healthcare decisions.

Important Names and Numbers My Name:

Home phone:

Cell phone:

Address:

E-mail address:

Insurance provider: Phone number:

Policy number:

E-mail address: Web site:

Primary care doctor: Phone number:

Address: E-mail address:

Web site:

Gynecologist: Phone number:

Address: E-mail address:

Web site:

Pharmacy: Phone number:

Address: E-mail address:

Web site:

Other (specify): Phone number:

Address: E-mail address:

Web site:

Other (specify): Phone number:

Address: E-mail address:

Web site:

Other (specify): Phone number:

Address: E-mail address:

Web site:

Other (specify): Phone number:

Address: E-mail address:

Web site:

Other (specify): Phone number:

Address: E-mail address:

Web site:

Other (specify): Phone number:

Address: E-mail address:

Web site:

Health History

Procedures/Surgeries/Childbirths Year

ImmunizationsVaccine Date Health Professional & Location

Measles, Mumps, Rubella

Varicella (chickenpox)

Meningococcal (per risk)

Tetanus, Diphtheria, Pertusis (every 10 years)

Hepatitis A (per risk)

Hepatitis B (per risk)

Influenza (Flu Shot) (Every fall or winter)

Pneumococcal (Age 65 and older or per risk)

Zoster (Shingles) (Age 60+)

Drug Allergies

Drug Reaction

Medical / Lab Testing (e.g. blood pressure, cholesterol levels, Pap test, mammogram, bone density...)

Date Name of test Results

Symptoms

Symptom Pain Level (1-10)* Date Time

Symptom Pain Level (1-10)* Date Time

Symptom Pain Level (1-10)* Date Time

Symptom Pain Level (1-10)* Date Time

Symptoms

Symptom Pain Level (1-10)* Date Time

Symptom Pain Level (1-10)* Date Time

Symptom Pain Level (1-10)* Date Time

Symptom Pain Level (1-10)* Date Time

* If applicable.

Healthcare AppointmentsName of healthcare provider: Date:

Reason for the appointment:

Questions for your healthcare provider:

Name of healthcare provider: Date:

Reason for the appointment:

Questions for your healthcare provider:

Name of healthcare provider: Date:

Reason for the appointment:

Questions for your healthcare provider:

Healthcare AppointmentsName of healthcare provider: Date:

Reason for the appointment:

Questions for your healthcare provider:

Name of healthcare provider: Date:

Reason for the appointment:

Questions for your healthcare provider:

Name of healthcare provider: Date:

Reason for the appointment:

Questions for your healthcare provider:

Medicines and Other TherapiesName of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Medicines and Other TherapiesName of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Name of medication/therapy :

What does it do?

Side Effects:

Dosage: Start/End date:

Insurance and Reimbursement CorrespondenceDate: Who did you contact?

Next steps and outcomes:

Date: Who did you contact?

Next steps and outcomes:

Date: Who did you contact?

Next steps and outcomes:

Date: Who did you contact?

Next steps and outcomes:

Date: Who did you contact?

Next steps and outcomes:

Date: Who did you contact?

Next steps and outcomes:

Date: Who did you contact?

Next steps and outcomes:

Conditions, Symptoms and Doctors This list is not all-inclusive and some women with these conditions will not experience any symptoms listed. Talk to your doctor to learn more and please visit www.womenshealth.gov and www.EverydayHealth.com for more information.

Conditions Possible Symptoms* Type of Doctor to See

Fibroids &Endometriosis

Pelvic pain, painful periods, painful intercourse, infertility PCP, GYN, OB/GYN

Prolapse

Sensation of sitting on a small ball, frequent urination, painful sex, repeated bladder infections, vaginal bleeding, protruding tissue, sensation of heaviness or pulling in the pelvis, lower back pain

PCP, GYN, OB/GYN, UROGYN

Urinary Incontinence

Urine leakage, cannot control urge to urinate

PCP, Urologist, OB/GYN, UROGYN

Cervical Cancer, Uterine & Endometrial Cancer

Abnormal vaginal bleeding, longer or heavier menstrual periods, pelvic pain, pain during sex

OB/GYN, GYN Oncologist

Ovarian CancerAbnormal vaginal bleeding or discharge, pelvic or back pain, bloating, change in bathroom habits

OB/GYN, GYN Oncologist

Colorectal Cancer

Blood in stool, persistent stomach pain, unexplained weight loss, there are not always symptoms

OB/GYN, GYN Oncologist

Breast CancerLump in breast, swelling or skin irritation, breast pain, nipple pain or inverted nipple, abnormal fluid

PCP, OB/GYN, GYN Oncologist

MenopauseHot flashes, trouble sleeping, night sweats, vaginal changes, mood swings, irregular periods, osteoporosis

PCP/GYN

Osteoporosis Height loss, curve in back, back pain, hunched posture, sloping shoulders

PCP, GYN, Rheumatologist

Conditions, Tests and Treatment Options This list is not all-inclusive and some women with these conditions will not experience any symptoms listed. Talk to your doctor to learn more and please visit www.womenshealth.gov and www.EverydayHealth.com for more information.

Conditions Common Tests* Treatment Options*

Fibroids Pelvic exam, Ultrasound, MRI, X-rays, CT scan, Hysteroscopy

• Medication• Endometrial Ablation• Uterine Fibroid Embolization• da Vinci Surgery• Laparoscopic surgery• Open surgery

Endometriosis Pelvic exam, Ultrasound, Laparoscopy

• Pain medication• Hormones (e.g. birth control) • da Vinci Surgery • Laparoscopic surgery • Open surgery

Prolapse Pelvic exam, Questionnaire, Imaging tests

• Lifestyle changes (e.g. Kegel exercises, maintain healthy weight) • Vaginal Pessary• da Vinci Surgery• Laparoscopic surgery• Open surgery

Urinary Incontinence

Bladder stress test, Urinalysis, Ultrasound, Cystoscopy, Urodynamics

• Lifestyle changes (Kegel exercises, weight loss)• Medications• Supportive devices• da Vinci Surgery• Open Surgery

Cervical Cancer Pap test, Pelvic exam, HPV test, Biopsy

• da Vinci Surgery• Open Surgery• Radiation• Chemotherapy

Conditions Common Tests* Treatment Options*

Uterine or Endometrial Cancer

Pelvic exam, Transvaginal ultrasound, Biopsy

• da Vinci Surgery• Open Surgery• Radiation• Hormone Therapy• Chemotherapy

Ovarian Cancer Pelvic exam, Transvaginal ultrasound, Blood test, Biopsy

• da Vinci Surgery• Open Surgery• Radiation• Chemotherapy

Colorectal Cancer

High-sensitivity stool test, Sigmoidoscopy, Colonoscropy

• da Vinci Surgery• Open Surgery• Radiation• Chemotherapy

Breast Cancer Self exam, Clinical breast exam, Mammogram, MRI

• Surgery• Radiation• Hormone therapy• Targeted therapy• Chemotherapy

Menopause None• Medications• Lifestyle changes• Hormone therapy

Osteoporosis Bone density test

• Calcium and vitamin D• Healthy diet• Weight-bearing exercise• Medication• Hormone therapy

Calendar: Notes:MAY 2011

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29 30 31

JULY 2011

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3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24/31 25 26 27 28 29 30

JUNE 2011

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1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30

SEPTEMBER 2011

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11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

AUGUST 2011

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14 15 16 17 18 19 20

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28 29 30 31

OCTOBER 2011

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23/30 24/31 25 26 27 28 29

DECEMBER 2011

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18 19 20 21 22 23 24

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NOVEMBER 2011

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13 14 15 16 17 18 19

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27 28 29 30

JANUARY 2012

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15 16 17 18 19 20 21

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29 30 31

MARCH 2012

S M T W T F S

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FEBRUARY 2012

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APRIL 2012

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29 30

Notes:

As with any program, individual results may vary. All persons depicted are models. All trademarks and logos are properties of their respective owners. PN 873531 Rev. A 3/11.

*Information available from: http://www.womenshealth.gov http://www.nlm.nih.gov/medlineplus http://www.cancer.org http://www.cdc.gov/cancer http://www.cancer.gov

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in the program material by patients or doctors about da Vinci Surgery are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor.