General Practitioner Template
Family planning/Contraceptive advice
A professional General Practitioner template for healthcare professionals.
About this template
This Family Planning/Contraceptive Advice template is designed for clinicians to document consultations focused on contraception. It includes sections for patient history, medical history, lifestyle factors, and detailed contraceptive options discussed during the visit. The template ensures comprehensive coverage of all relevant aspects, from current and previous contraceptive methods to reproductive goals and lifestyle considerations. It also outlines the current plan, including the selected method, next steps, and patient education. This template is ideal for clinicians providing family planning services and aims to streamline documentation while ensuring thorough patient care.
Preview template
Reason for Visit:
- Primary Concern: Contraception Advice
Patient History:
- Age: 29 years old
- Menstrual History: Regular menstrual cycles, 28-day cycle
- Current Contraceptive Method: Not currently using any contraception
- Previous Contraceptive Methods: Previous use of condoms and oral contraceptives
- Reproductive Goals: Not planning for pregnancy in the near future, considering family planning options
Medical History:
- Chronic Conditions: No significant chronic conditions reported
- Gynaecological History: No history of pelvic inflammatory disease, endometriosis, or uterine fibroids
- Obstetric History: No previous pregnancies or live births
- Medications: No current medications
Lifestyle Factors:
- Sexual History: Active, with regular intercourse
- Lifestyle: Non-smoker, minimal alcohol use, regular exercise
- Weight and Nutrition: Normal weight, balanced diet
Consultation Details:
1. Contraceptive Options Discussed:
- Hormonal Methods:
- Oral Contraceptives: Combined hormonal pills, progestin-only pills
- Contraceptive Patch: Weekly patch application
- Hormonal Injections: Depot medroxyprogesterone acetate every 3 months
- Implants: Nexplanon, inserted under the skin, effective for up to 3 years
- Intrauterine Devices (IUDs):
- Copper IUD: Non-hormonal, effective for up to 10 years
- Hormonal IUD: Releases levonorgestrel, effective for up to 5 years
- Barrier Methods:
- Condoms: Male or female condoms
- Diaphragms and Cervical Caps: Used with spermicide
- Permanent Methods:
- Tubal Ligation: Surgical procedure to block fallopian tubes
- Vasectomy: Male sterilization
- Fertility Awareness Methods: Tracking menstrual cycles, basal body temperature
- Emergency Contraception:
- Emergency Contraceptive Pills: Plan B, Ella
- Copper IUD: Can be used as emergency contraception if inserted within 5 days
2. Considerations for Choice:
- Effectiveness: Hormonal methods and IUDs are highly effective
- Side Effects: Discuss potential side effects for each method
- Patient Preferences: Preference for hormonal vs. non-hormonal methods
- Health Conditions: Any contraindications based on the patient’s health history
3. Current Plan:
- Selected Method: Patient chose to start hormonal IUD
- Next Steps: Schedule insertion of IUD, discuss follow-up care
- Education Provided: Instructions on use, potential side effects, and when to seek medical advice
Follow-Up:
- Appointment: Follow-up appointment in 6 weeks to check on the IUD placement and address any concerns
- Contact Information: Provide contact details for questions or emergencies related to contraception
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Signature:
Dr. Thomas Kelly
General Practitioner
123-456-7890
Date: 2023-10-01
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