Checklist for examining patients who wish to start using contraceptive implants

The checklist consists of 11 questions and provides advice based on the responses of patients. The first 5 questions are designed to identify diseases that would prevent safe use of implants or require further evaluation. Patients who are excluded because of their response to some of the questions that determine medical eligibility may still be eligible to use implants if the alleged disease can be ruled out through proper evaluation. The last 6 questions allow providers to determine with reasonable certainty that the woman is not pregnant before you start using contraception.

A health care provider should complete the checklist before placing or implants. In some contexts, the responsibility for initiating the use of implants can be shared by a counselor to complete the checklist and by a provider trained to perform medical care placement. Among the trained providers to place implants may include nurses, nurse midwives, nurse practitioners, midwives, doctors and, according to the educational and professional standards of each country, medical assistants and associates.

Clinical Guidelines
Family Planning
Health Care Workers
FHI 360
U.S. Agency for International Development

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