Document the Pre-Procedure Details for Diaphragm/Cervical Cap

You can document the pre-procedure details of the Diaphragm/Cervical Cap procedure in the Pre-Procedure section on the Diaphragm/Cervical Cap - Procedure template.

1. Open the Diaphragm/Cervical Cap - Procedure template.
2. Select the last menstrual period in LMP.
   Note: If the LMP is entered on the Vital Signs template, LMP appears automatically in the field.
3. To indicate postpartum, select the Postpartum check box.
4. Select the pre-op contraception method.
5. Optional: Select the following check boxes.
   • Negative pregnancy test
   • Correct patient is identified
   • Procedure/risks were explained
   • Questions were answered
   • Consent was obtained
   • Correct side and site confirmed
6. Indicate the presence of Gonorrhea or Chlamydia.
7. Select the Consent link and do the following in the Consent - Procedure template to obtain the procedure consent.
   1. Select the provider.
   2. In Consent by, select the person's name who consented to the procedure.
   3. Select the procedure type and date.
      If the date is not fixed, select the To be scheduled in the near future check box.
   4. Optional: Select the Procedure, treatment alternatives, risks and benefits were explained. specific risks discussed and the specific risks check boxes.
   5. Select Repeat Procedure if the procedure needs to be repeated.
   6. Optional: Enter additional details in Other.
   7. Optional: Select the following check boxes.
      • Questions were answered
      • The patient agrees, verbalizes understanding and wants to proceed
      • The patient's guardian/parent(s) agrees, verbalizes understanding and wants to proceed
      • Educational handouts given
      • Preoperative instructions and paper work completed
   8. Enter additional details in Comments.
   9. Select Save & Close.