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FPP Policy Manual

 

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Updated:  September 18, 2017
 

TITLE SECTION PAGES
 

Medical Director Signature

1      
 

Introduction

1      
 

Table of Contents

3      
Section I

General Administration

9      
Section II

Program Services

12      
Section III

Client Care

35      
Section IV

Related Services

4      
Sestion V

Financial Management

16      
Section VI

Legal Issues

5      
Section VII

Definitions

3      
Section VIII

Sources

1      
Additional Information

Title X - Attachment A

Title X - Attachment B

WV Code for Family Planning and Child Spacing

WV AIDS Prevention Centers

HHS Policy for Sterilization of Persons in Federally Assisted Family Planning Programs

Doe v. Pickett

Supply Request Form  

Supply Request For Referrals (L528) 

Literature Order Form 

Formulary

Instructions for the Collection, Submission Form and
     Mailing Of Chlamydia/Gonorrhea Urine Specimens

Instructions for the “Requisition Form for Specimen
     Mailing Kits"

Instructions for the Collection, Submission Form and
     Mailing of HIV Specimens

Diagnostic Immunology Laboratory Specimen Submission  

Pap Test Activity Log

Region III - Infertility Prevention Project

Statement of Drugs Administered to STD Clients

Family Planning Program Clinics 

IUD, Nexplanon, and Sterilization Providers  

 

4

10

 

 

6

 

2

1
1

1

 

4

 

2

 

1

1

1

59

1

7

34

 

Medical Records & Client Services

Basic Data    Updated

Reproductive Life Form  Updated

Medical History (L518)

Progress Notes/Order Sheet (L519)

Client Education and Counseling Checklist (L561)

Consent for Deferred Physical Examination (L521)

Nexplanon In-Take Form (L530)

Intrauterine Device In-Take Form (L501)

Voluntary Sterilization In-Take Form (L522)

Consent for Sterilization (HHS-687) 

 

General Resource Tools

For Pap Protocols please visit The American Congress of Obstetricians and Gynecologists - ACOG

Preconception Screen Counseling Checklist

Sexual Exposure Chart

Male Sterilization - The Facts

Female Sterilization - The Facts

Service Components by Category

Pregnancy Resources List

 

SPANISH

Consent for Sterilization - Spanish (L553-S)

1

1

2

1

1

1

1

1

1

2

 




1
1
4
4

1

1


2

Additional Billing Information

Patient Data Form (L5501)

WV County Resident Codes

FPEDs User ID Request Form
Invoice for Batch
Providing Quality Family Planning Services (QFP)
QFP Update - March 11, 2016
Program Requirements for Title X Funded Family Planning Projects

Sliding Fee Scale - 2016
Sliding Fee Scale - 2017

 

2

1

2

1

60

 

22

1

1

 

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