WV - DHHR - BPH - OMCFH - Family Planning Program


FPP Policy Manual

TITLE SECTION PAGES
     
  Medical Director Signature  
     
  Introduction  
     
Section I General Administration  
     
Section II Program Services  
     
Section III Client Care  
     
Section IV Related Services  
     
Section V Financial Management  
     
Section VI Legal Issues  
     
Section VII Definitions  
     
Section VIII Sources  
     
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

6

     
  Doe v. Pickett  
     
  Supply Request Form  
2
     
  Supply Request For Referrals (L528)
1
     
  Off-Formulary Product Reqauest Form
1
     
  Literature Order Form 
1
   
  Formulary
1
   
  Instructions for the Collection, Submission Form and
     Mailing Of Chlamydia/Gonorrhea Urine Specimens
4
   
  Instructions for the “Requisition Form for Specimen
     Mailing Kits"
2
   
  Instructions for the Collection, Submission Form and
     Mailing of HIV Specimens
4
   
  Diagnostic Immunology Laboratory Specimen Submission 
1
   
  Pap Test Activity Log
1
   
  Region III - Infertility Prevention Project
58
   
  Statement of Drugs Administered to STD Clients
1
   
  Family Planning Program Clinics 
7
   
  IUD, Nexplanon, and Sterilization Providers 
34
     
     
Medical Records & Client Services
   
1
  Patient Information Form
   
  Reproductive Life Form  
1
   
  Medical History (L518)
2
   
  Progress Notes/Order Sheet (L519)
1
   
  Client Education and Counseling Checklist (L561)
1
   
  Nexplanon In-Take Form (L530)
1
   
  Intrauterine Device In-Take Form (L501)
1
   
  Voluntary Sterilization In-Take Form (L522)
1
   
  Consent for Sterilization (HHS-687) 
2
     
  Nexplanon Consent Form
2
   
  General Resource Tools
     
  For Pap Protocols please visit The American Congress of Obstetricians and  
     
  Gynecologists - ACOG  
     
  Preconception Screen Counseling Checklist  
     
  Sexual Exposure Chart
1
   
  Male Sterilization - The Facts
1
   
  Female Sterilization - The Facts
4
   
  Service Components by Category - COMING SOON
4
   
  Pregnancy Resources List
1
   
  Referral Services List
2
   
  SPANISH
   
  Consent for Sterilization - Spanish (L553-S)
2
     
Additional Billing Information
   
  Data Collection Form  PDF
2
   
  WV County Resident Codes
1
   
  FPEDs User ID Request Form
2
   
  Invoice for Batch
1
   
  Providing Quality Family Planning Services (QFP)
60
   
  QFP Update - March 11, 2016
   
  Program Requirements for Title X Funded Family Planning Projects
22
     
  Sliding Fee Scale - 2022 - July 2022 - March 2023 - PDF
1
   
  Sliding Fee Scale - 2021 - September 2021 - June 2022
1
     
  Sliding Fee Scale - 2021 - July 2021-August 2021
1
   
  Sliding Fee Scale - 2020
1
   
  Bypass Payment Invoice - February 2019
1
   
  Batch Sheet for Bypass Patients
1
   
  Batch Sheet
1
   
  HCFA 1500
2