FAMILY PLANNING PROGRAM INFORMED CONSENT FOR CONTRACEPTIVE METHODS (Prescription & Non-Prescription) ORAL CONTRACEPTIVES I have chosen oral contraceptives as my method of contraception. I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of oral contraceptive use. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________
DEPO-PROVERA I have chosen Depo-Provera as my method of contraception. I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of Depo-Provera. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________
NUVA RING I have choosen the Nuva Ring as my method of contraception, I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of Nuva Ring. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________
BARRIERS (Condoms, Foams, or Diaphragm) I have chosen to use a barrier as my method of contraception. I have been provided counseling and written information regarding the benefits, risks, effectiveness, potential side effects, and complications related to the use of this method. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________ INTRAUTERINE DEVICE (IUD) I have chosen the Intrauterine Device (IUD) as my method of contraception. I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of the IUD. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________ IMPLANON I have chosen the Implanon as my method of contraception. I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of the Implanon. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________
EMERGENCY CONTRACEPTION (PLAN B) I have requested Plan B for emergency contraceptive use. I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of using Plan B. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________ ORTHO EVRA “The Patch” I have chosen Ortho Evra transdermal system as my method of contraception. I have been provided counseling and written information regarding the benefits and risks, effectiveness, potential side effects, complications, and danger signs of Ortho Evra transdermal system use. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________ NATURAL FAMILY PLANNING (CycleBeads) OR FERTILITY AWARENESS METHOD I have chosen to use Natural Family Planning for Fertility Awareness as my method of contraception. I have been provided counseling and written information regarding the benefits, risks, effectiveness and complications related to the use of this method. I have been given the opportunity to ask questions and I understand the information that has been provided to me. _________________________________
12 and 15 lead ECG Interpretation Lead Placement: even if you are not performing the test itself, knowledge of the correct lead placement is useful in troubleshooting an ECG test. V2 : feel for the space between the left clavicle and the rib beneath, place your baby finger there and feel down with subsequent fingers until your index is resting on the 4th rib space (4th intercostal spac
C.CLIN Sud-Est – Septembre 2004 Conduite à tenir en cas d’une épidémie de gale en établissement de santé Définition : la gale est une ectoparasitose (parasite externe) à Sarcoptes scabiei variété hominis qui vit dans l’épiderme humain, à l’origine d’une dermatose très prurigineuse et contagieuse. I. Contexte épidémiologique Le sarcopte a un aspec