Cervical cancer is Indonesia's second leading cause of death, following only breast cancer. According to the World Health Organization (WHO), non-communicable disorders will blame for 70% of all deaths and illnesses in 2020, while other disease types will account for 60%. Cervical cancer can be detected earlier, lowering the chance of death. This study aimed to validate and check the pap smear test results obtained from the previously conducted pap smear screening program. The pap smear questionnaire developed would help in the compilation of a patient's habit history that has undergone a pap smear test during his life based on the factors associated with the occurrence of cervical cancer. Specific details, social-demographic features, diet, genital hygiene activities, reproductive background and behaviors, and health care and cancer prevention behavior are also included in the questionnaire template. The consequence of this design is the completeness of evidence on the theory of anomalies dependent on the findings of pap smear sampling.