img button button button button button button
 

Aftercare Instructions

 

 

AUTHORIZATION FOR 24-HOUR POST-OP FOLLOW UP CALL, INSTRUCTIONS AND COUNSELING CHECK LIST(COUNSELOR MUST INITIAL EACH OF THE FOLLOWING LINES, WHICH INDICATES AFFIRMATIVELY THAT PATIENT WAS COUNSELED ABOUT EACH ITEM LISTED)

BY THE END OF THE COUNSELING SESSION, HAVE YOU?

 

____  AUTHORIZATION FOR OUR DOCTOR OR REGISTERED NURSE TO CALL HER WITHIN 24 HOURS AND ASSESS HER RECOVERY: GRANTED (___) DENIED (___)
PATIENT'S CELLULAR PHONE #_________________________
PATIENT'S PHONE ABLE TO TEXT? YES (___) NO (___)
HER E-MAIL IS:____________________________

_____REASSURED PATIENT THAT WHAT SHE TELLS US WILL BE HELD IN THE STRICTEST OF CONFIDENCE, IN COMPLIANCE WITH HIPPA LAW

_____ ASKED PATIENT THE PHONE NUMBER OF HER EMERGENCY CONTACT AND IF HE/SHE KNOWS OR NOT ABOUT THIS ABORTION YES (___) NO (___)

_____ALSO ASKED PATIENT IF OUR STAFF MAY LEAVE A MESSAGE WITH HER CONTACT PERSON

_____ASCERTAINED THAT PATIENT’S PREGNANCY TEST IS POSITIVE (___) AND PATIENT IS (___) WKS PREGNANT FROM HER LAST MENSTRUAL PERIOD (LMP)

_____ASKED IF SHE HAS ANY MEDICAL CONDITIONS: ANEMIA, HEART OR KIDNEY DISEASE, HIV, HIGH BLOOD PRESSURE, DIABETES, SMOKER, DRUG ADDICTION, ALLERGIES, OR ANY OTHER CONDITIONS AS PER  HISTORY INTAKE (PAGE ONE); AND TO LIST ALL CURRENT MEDICATIONS
_____DISCUSSED THE ALTERNATIVES TO ABORTION, INCLUDING PARENTING, ADOPTION, AND FOSTER CARE; AND THE RISKS OF EACH ONE.
_____ASKED IF SHE WOULD CONSIDER ADOPTION INSTEAD OF HAVING AN ABORTION AND IF SO, OFFERED TO PROVIDE PRINTED INFORMATION ON ADOPTION ____
ASKED IF SHE WOULD LIKE TO SEE AND HAVE EXPLAINED THE REAL-TIME ULTRASOUND EXAM THAT OUR DOCTOR WILL PERFORM  BEFORE THE ABORTION
_____DISCUSSED THE RISKS OF AN ABORTION; POSSIBLE COMPLICATIONS OF ABORTION; AND THE POST-PROCEDURE CARE

_____EXPLAINED TO PATIENT THAT FOR SAFETY REASONS, WE DO NOT OFFER GENERAL (“TOTALLY ASLEEP”) ANESTHESIA                                                                                  

_____TOLD PATIENT THAT ADVANCED  IV MODERATE SEDATION PROVIDES  COMFORT, SLEEPINESS AND THE ABILITY TO TOLERATE  THE PROCEDURE WELL

_____ASKED IF PATIENT KNOWS HER BLOOD RH TYPE: Rh POSITIVE _____ Rh NEGATIVE _____ (WE WILL CONFIRM PATIENT'S Rh- TYPE, ANYWAY)

_____MADE PATIENT AWARE OF POSSIBILITY OF SPECIAL SITUATIONS THAT MAY INVOLVE EXTRA CHARGES: Rh--NEGATIVE BLOOD; IF PREGNANCY OVER 12 WEEKS                  AND PRIOR C/SECTION;  IF NO PREGNANCY IS FOUND ON THE PRELIMINARY ULTRASOUND;  IF SHE MAY HAVE/ OR HAS AN ECTOPIC PREGNANCY

_____ MADE CERTAIN THAT THE PATIENT'S DECISION TO TERMINATE THIS PREGNANCY IS VOLUNTARY, WELL INFORMED AND HAS BEEN MADE FREELY
_____INFORMED PATIENT THAT TODAY SHE MAY SPEND ABOUT 3-­-4 HOURS AT OUR FACILITY, UNTIL IT IS SAFE FOR HER TO BE DISCHARGED                           

 _____EXPLAINED THE ABORTION METHODS, AND THE CONSENTS FOR VACUUM ASPIRATION AND FOR A LIMITED ULTRASOUND EXAM

_____APOLOGIZED FOR INTRUDING ON HER PRIVACY WITH QUESTIONS ABOUT HER INCOME IN ORDER TO OBTAIN FINANCIAL ASSISTANCE OR NAF FUNDING
_____ADDRESSED THE IMPORTANCE OF SAFE SEXUAL PRACTICES AND EFFECTIVE CONTRACEPTION.
ASKED IF SHE HAS A PRIOR HISTORY OF STD

_____OFFERED PATIENT A CHOICE OF BIRTH CONTROL: THE PILL ___ DEPO PROVERA ____ IUD ___ VAGINAL RING ___ CONDOM ___ IMPLANON ____ VAGINAL                          DIAPHRAGM ___ TUBAL LIGATION ___ VASECTOMY ____ ABSTINENCE ____ BACKUP MORNING AFTER PILL____

_____OFFERED TO FILL THE PRESCRIPTION OF ANTIBIOTICS AND/OR PAIN MEDICATIONS HERE IN OUR OFFICE  OR GIVE THE PRESCRIPTION FOR A PHARMACY
_____ASKED IF SHE IS CURRENTLY BREAST FEEDING; AND IF SO, INSTRUCTED PATIENT NOT TAKE DOXYCYCLINE TO PREVENT AN INFECTION
_____INSTRUCTED PATIENT ON THE FOLLOWING POST- PROCEDURE INSTRUCTIONS:

                (A) MUST BEGIN TAKING THE ANTIBIOTIC DOXYCYCLINE TODAY  WITH HER NEXT MEAL,  EVERY 12 HOURS, AND  AVOID SUN BATHING, ALCOHOL, SPICY FOOS                 (B) BEGIN THE BIRTH CONTROL PILL THIS SUNDAY (THE FIRST SUNDAY AFTER THE ABORTION),  PREFERABLY AFTER  DINNER

                (C) MOTRIN (IBUPROFEN) SHOULD BE TAKEN ONLY FOR PAIN, AND NOT TO EXCEED 2400 MG IN 24 HRS (ONE 800 MG TABLET 3 TIMES A DAY)
                (D) DO NOT INSERT ANYTHING VAGINALLY FOR THE NEXT 2 WEEKS, INCLUDING CREAMS, VAGINAL DOUCHES AND SEXUAL INTERCOURSE

                (E) REST AS MUCH AS POSSIBLE AND DO NOT DRIVE FOR 24 HOURS AFTER THE PROCEDURE.
                (F) INSTRUCTED PATIENT TO CALL THE DOCTOR AT (954) 772-0933 IF HAVING FEVER OVER 100.4 DEGREES AFTER THE FIRST FOUR HOURS FOLLOWING THE                PROCEDURE; SKIN RASH, PERSISTENT NAUSEA, VOMITING, DIARRHEA, HEAVY BLEEDING OR HEMORRHAGING FOR MORE THAN 12 HRS. REMEMBER  IT IS                          NORMAL IF YOU DO NOT HAVE ANY BLEEDING OR IF YOUR  BLEEDING IS INTERMITTENT, AS LONG AS ITS AMOUNT IS NOT EXCESSIVE.                              

                         ALL WOMEN'S CLINIC EMERGENCY NUMBERS ARE (954)772-0933 AND (954) 805-5821 TOLL-FREE 1 (800) 867-1693  

                (G) INSTRUCTED PATIENT TO CALL 911 AND GO TO THE CLOSEST HOSPITAL EMERGENCY ROOM IF HAVING RAPID PULSE (OVER 100 BEATS PER MINUTE); ANY                          UNUSUAL BEHAVIOR, FEELS DISORIENTED OR DIZZINESS, EXPERIENCES SHARP OR STABBING ABDOMINAL PAINS OR EXCESSIVE VAGINAL BLEEDING                          THAT COMPLETELY SOAKS ONE THICK SANITARY PAD OR FILLS ONE CUP WITH LARGE CLOTS WITHIN ONE HOUR

                (H) EXPLAINED THE DIET AFTER THE PROCEDURE, NAMELY, TO BEGIN TAKING FLUIDS AS SOON AS POSSIBLE. THE FOLLOWING FLUIDS WILL BE MOST EASILY                          TOLERATED AND ARE RECOMMENDED: WATER, GATORADE, BROTH, JELLO AND ICE TEA. IF FLUIDS ARE WELL TOLERATED, YOUR DIET MAY BE QUICKLY                          INCREASED TO NORMAL. AVOID ALCOHOLIC BEVERAGES, GREASY AND SPICY FOODS. AVOID HEAVY LIFTING OVER 35 LBS                                         

                (J) TOLD PATIENT SHE SHOULD NOT DRIVE FOR 24 HOURS

_____ TOLD PATIENT TO KEEP A  COPY OF THIS COUNSELING AND INSTRUCTIONS CHECKLIST, AND THE PINK COPY OF HER RECEIPT, FOR FUTURE REFERENCE

_____ MADE AN APPOINTMENT FOR A FREE FOLLOW-­-UP EXAM IN 2 WK (IF SHE HAD A MEDICATION ABORTION); OR IN 3 WK (IF SHE HAD A SUCTION CURETTAGE)

_____ ADVISED PATIENT THAT SHE CAN GET A LOW COST PAP TEST (CERVICAL CYTOLOGY TESTING) OR AN INTRAUTERINE DEVICE (IUD) AT HER FOLLOW-UP VISIT

_____ ASKED PATIENT IF I CAN ANSWER ANY ADDITIONAL QUESTIONS AND ADVISED HER TO VISIT  ALLWOMENSCLINIC.COM AT ANY TIME

 

I UNDERSTAND THAT IF I SEEK TREATMENT FROM ANY PHYSICIAN OR MEDICAL FACILITY OTHER THAN FROM ALL WOMEN'S CLINIC, SUCH CARE WILL BE AT MY OWN FINANCIAL EXPENSE. I ALSO UNDERSTAND THAT ANY PROBLEMS AND/OR COMPLICATIONS THAT ARE MADE WORSE BY MY FAILURE TO OBTAIN A BLOOD TESTING THAT HAD BEEN ORDERED BY OUR PHYSICIAN; OR FROM NOT RETURNING TO SEE US WITHIN THREE WEEKS FOR THE FOLLOW UP EXAM ARE MY RESPONSIBILITY, NOT THAT OF THE CLINIC, ITS DOCTOR(S), OR ANY OTHER CLINIC PERSONNEL

 

I HEREBY CERTIFY THAT I WAS GIVEN A PRIVATE OPPORTUNITY TO DISCUSS ISSUES AND CONCERNS ABOUT MY ABORTION; THAT ALL MY QUESTIONS WERE ANSWERED TO MY COMPLETE SATISFACTION; AND THAT I RECEIVED A BLANK COPY OF THIS FORM

OUR 24-HOUR EMERGENCY NUMBERS ARE (954) 772-0933 AND (954) 805-5821 TOLL-FREE 1 (800) 867-1693.     WE RECOMMEND YOU VISIT

 

             

   

  OUR INFORMATIVE WEBSITEALLWOMENSCLINIC.COM

 

If you would like more information, you may contact us at any of the following numbers:

Toll Free: (800) 867-1693 Local calls: (954) 772-HELP (4357) or (954) 772-0933
You also may text your message to: (954) 805-5821

All calls are kept strictly confidential


Our address is: 2100 E Commercial Blvd, Fort Lauderdale, Florida 33308-3822




[aarowClick here to go back to top]


[aarowClick here to go back to the Home Page]