Contraceptive Service Visits Pregnancy Testing STD Testing Initial and Annual Visit Deferred Exam Supply/follow up visit Emergency Contraception Visit As clinically indicated: Pap test as recommended by Cancer Screening Guidelines. routine screening for age < 24 years STD, HIV, Hepatitis C based on sexual health history Other per patient assessment Pregnancy test, if indicated STD, HIV, Hepatitis C based on sexual health history routine screening for age < 24 years Other per patient assessment STD, HIV, Hepatitis C testing, if indicated STD, HIV, Hepatitis C testing, if indicated Urine Pregnancy Test Negative Result STD, HIV, Hepatitis C testing based on risk factors routine screening for age < 24 years Positive Results Follow prenatal guidelines for labs if services provided in LHD STD, HIV, and HCV testing as indicated Other tests, as indicated (e.g. HBV) See STD guidelines FPEM 19 – Family Planning Booklet Reproductive Life Plan Method specific FPEM Contraceptive method of choice Follow up visit as needed Counsel client as indicated based on history and assessment Adolescent Client Counseling: Abstinence Parental Involvement Sexual Coercion FPEM 19 – Family Planning Booklet Reproductive Life Plan Method specific FPEM Contraceptive method of choice Follow up visit as needed Adolescent Client Counseling: Abstinence Parental Involvement Sexual Coercion As assessed for individual patient needs Follow appropriate contraceptive services protocol if patient desires contraceptive method. May provide the following, if indicated: FPEM-1 Benefits of planned pregnancy; compliance with routine method FPEM-2 Emergency Contraception ACHI-9 Healthier Lifestyles for Family Planning Negative Pregnancy test Follow appropriate contraceptive services protocol if patient desires contraceptive method. May provide the following, if indicated: FPEM-1 Benefits of planned pregnancy; compliance with routine method FPEM-2 Emergency Contraception ACHI-9 Healthier Lifestyles for Family Planning POSITIVE PREGNANCY TEST Options Counseling to identify woman’s choice to maintain the pregnancy, adoption, or termination of pregnancy Counseling messages should include (see STD guidelines): Take medications as directed Abstain from sex until the patient and patient’s partner(s) have been completely treated Return for follow-up appointments How to obtain test results Safe sex, risk reduction counseling Pregnancy prevention annual annual annual
Initial and Annual Visit Deferred Exam Supply/follow up visit Emergency Contraception Visit Pregnancy Testing STD Testing Topics to consider: Benefits of family planning; resources for mental health and/or substance abuse; domestic violence hotline and rape crisis hotline; how to use a condom; STD/HIV education; screening pap test; other topics as indicate Counsel client, as indicated, based on history and assessment. See “Topics to consider” in the initial and visit column As indicated from options counseling: PAM-ACH 8 Prenatal Care MCH 25 What is Lead? (see Lead Section recommendations for verbal risk assessment guidelines) Contraceptive method of choice Multivitamins (Folic Acid supplementation) Follow-up visit as indicated Backup barrier method As assessed for individual patient needs Provide 24 hour Emergency Number Contraceptive method of choice- up to 3 month supply Multivitamins (Folic Acid supplementation) Follow-up visit for exam and as indicated Backup barrier method Provide 24 hour Emergency Number RN may provide OCPs, DMPA, rings or patches if unable to provide the initial/annual exam. The initial/ exam may be deferred up to 3 months if the physician/APRN responsible for the medical direction of family planning services signs the deferred exam protocol (ACH 264B). Contraceptive method of choice Provide with FDA Approved emergency contraception May provide with contraceptive method of choice as defined in the deferred exam protocol Schedule a family planning visit, as needed Provide backup or barrier method, as needed Multivitamins (Folic Acid supplementation) POSITIVE TEST - Provide services based on choice of options for pregnancy and resources for prenatal, care, adoption, foster care, or termination as appropriate. Presumptive eligibility and follow-up to Community Based Services for full Medicaid benefits (if indicated) A genetic services referral should be recommended for previous birth defects, including NTD Refer for prenatal appointment to LHD or private MD WIC referral Referral to HANDS or complete ACH-300 HANDS screen Prenatal Vitamins NEGATIVE TEST Emergency Contraception, if indicated See Contraceptive Services protocols, as indicated Follow-up appointment for test results and/or treatment Linkage for partner services Condoms Contraceptive method, as indicated Follow the contraceptive services protocol The Matrix identifies the minimal requirements for providing family planning services. Clinicians and nurses must follow the Title X Clinical Requirements outline in the Training Guidelines and Program Descriptions Section of the AR
PRECONCEPTION CARE The following family planning visits require that preconception health care be routinely provided: Initial family planning examination visit Annual family planning examination visit Initial women’s preventive health examination if of childbearing age without a permanent method of contraception (hysterectomy or tubal ligation) Pregnancy test visit (only if negative test results) Preconception interventions may include the following: A dialogue regarding the patient’s reproductive life plan and readiness and desire a for pregnancy An evaluation of her overall health and opportunities to improve her health Education about the significant impact that social, environmental, occupational, behavioral, and genetic factors may have on a future pregnancy Identification of women at high risk for an adverse pregnancy outcome with appropriate referrals to a health care professional Assessment and counseling should be provided only by a qualified provider who has training in risk identification with the ability to provide appropriate counseling and referrals. Assessment/counseling/referrals of pregnancy related risk factors include: Advanced maternal age (pregnancy at or over the age of 35)––poses a higher risk of chromosomal abnormalities in the fetus and medical problems to the mother during pregnancy Ethnic backgrounds––a family history that is positive for certain diseases may indicate the need for additional screening STD’s––early treatment decreases the risk of transmission to the fetus and preterm delivery Vaccination history (Refer to Immunizations Section) Chronic disease (hypertension, diabetes, obesity, epilepsy, DVT, depression) Alcohol, Tobacco, Other Drugs (ATOD) Domestic violence Exercise Nutrition References: FOLIC ACID SUPPLEMENTATION ALL female patients of childbearing age who have not had a hysterectomy or tubal ligation should be offered one three month supply of a multivitamin containing 0.4 mg folic acid free of charge and should