Checklist for examining patients who wish to start using DMPA (or EN) *

The checklist is designed for use by health care providers of clinical and non-clinical, including community health workers. It consists of 15 questions and provides advice based on the responses of patients. The first 9 questions are designed to identify diseases that would prevent safe DMPA use 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 DMPA, 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.

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

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