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Family Planning Contraceptive Implant Consent Form
Get Family Planning Contraceptive Implant Consent Form
Ave been counseled on the benefits/advantages and risks/disadvantages of the contraceptive implant method. I have read the FPEM-7 handout, as well as the manufacturers package insert. I was given the opportunity to ask questions and received answers. I understand that the contraceptive implant should be inserted within seven days of my last menstrual period. If I was using , then the contraceptive implant should be inserted at the time of my next injection. I am nor allergic to iodin.
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Insertion FAQ
There are 4 components of informed consent including decision capacity, documentation of consent, disclosure, and competency. Doctors will give you information about a particular treatment or test in order for you to decide whether or not you wish to undergo a treatment or test.
Its purpose is to help prevent decisions about contraception being made in an acute setting (that is, just before, during or after giving birth) and to ensure the patient's voice is heard and understood.
Informed Consent for Contraception is a shared decision-making guide that can be used in conversations with a patient about methods of birth control.
If you are 18 or older, parental permission is not required. Ask your health care provider if a long acting birth control would be a good method for you. Remember, both birth control methods do not prevent sexually transmitted infections (STI's).
I (patient name) give permission for [practice name] to give me medical treatment. I allow [practice name] to file for insurance benefits to pay for the care I receive. I understand that: [practice name] will have to send my medical record information to my insurance company.
The contraceptive implant () is a small flexible plastic rod that's placed under the skin in your upper arm by a doctor or nurse. It releases the hormone progestogen into your bloodstream to prevent pregnancy and lasts for 3 years.
In general, parental permission is not needed for prescription methods of birth control.
Intrauterine device (IUD) and are birth control options that can be used by teenagers. These devices are inserted into the uterus by a physician and can stay in place for several years.
Examinations Related content
Family Planning Forms & Teaching Sheets
FAMILY PLANNING FORMS & TEACHING SHEETS ... FP3 Consent for Insertion of the Contraceptive...
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