WICC & Contraception Clinic Note

HPI 

[text size="5"] yo [select name="wiccgender" value="F|M"] presents to clinic to discuss contraception.
[comment memo="
" memo_size="small" memo_color="whitesmoke"][conditional field="wiccgender" condition="(wiccgender).is('F')"]-After providing educational materials and discussion, patient desires [select name="wiccfreason" value="switching current contraceptive method|starting contraceptive method|continuing current contraceptive method|stopping current contraceptive method"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender" condition="(wiccgender).is('M')"][text default="elective sterilization through vasectomy" size="40"]
[/conditional][conditional field="wiccgender|wiccfreason" condition="(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')"]-current method: [select name="wiccswitchcontracurrent" value="Pill|Patch|Ring|Progestin shot|Progestin implant|Hormone IUD|Copper IUD|abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
-desired method: [select name="wiccswitchcontradesired" value="Pill|Patch|Ring|Progestin shot|Progestin implant|Hormone IUD|Copper IUD|abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
-reasons for desiring to switch method: [checkbox value="undesired irregular bleeding|undesired heavy bleeding|undesired lack of cycles|discomfort/pain|undesired mood disturbances|forgets to take pills|desires longer term contraceptive|desires hormone-free period|no anticipated intercourse due to spouse/partner geographically separated"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender|wiccfreason" condition="(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')"]-desired method: [select name="wiccstartcontradesired" value="Pill|Patch|Ring|Progestin shot|Progestin implant|Hormone IUD|Copper IUD|abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender|wiccfreason" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')"]-current method: [select name="wicccontinuecontracurrent" value="Pill|Patch|Ring|Progestin shot|Progestin implant|Hormone IUD|Copper IUD|abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender|wiccfreason|wicccontinuecontracurrent" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&((wicccontinuecontracurrent).is('Progestin implant')||(wicccontinuecontracurrent).is('Hormone IUD')||(wicccontinuecontracurrent).is('Copper IUD'))"]-desires removal/replacement of current device[comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender|wiccfreason" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender|wiccfreason" condition="(wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')"]-current method: [select name="wiccstopcontracurrent" value="Progestin implant|Hormone IUD|Copper IUD"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
-reasons for stopping current method: [checkbox value="desires to conceive|undesirable side effects|desires hormone free period"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
[/conditional][conditional field="wiccgender|wiccfreason" condition="(wiccgender).is('F')&&((wiccfreason).is('switching current contraceptive method')||(wiccfreason).is('continuing current contraceptive method')||(wiccfreason).is('starting contraceptive method'))"]
RELEVANT PMHX
-focused review of PMHx of patient revealed the following relative contraindications and medical considerations for contraceptives: 
[checklist value="currently breastfeeding infant less than 6mo old|current tobacco use (ie. cigarettes,chewing tobacco,vaping)|more than 35yo|history of breast cancer|history of stroke|prior DVT or PE|prior MI|history of migraines with aura|current treatment for TB or seizures|less than 6wks post-partum|history of gall bladder disease|history of severe liver disease/jaundice|history of HTN|history of DM|obesity|history of rheumatic disease (ie. lupus)"]

[/conditional][comment memo="
" memo_size="small" memo_color="whitesmoke"]PHYSICAL EXAM

[textarea rows="10"]-Vitals - reviewed, no remarkable abnormalities
-General - well developed, well nourished, no apparent distress
-HEENT - normocephalic, atraumatic, nares patent, mucous membranes moist
-Neck - no thyromegaly, no gross distention
-Abdomen - non-distended
-EXT - no cyanosis, no over/gross deformity
-PSYCH - appropriate mood/affect
-NEURO - appropriate mentation[/textarea][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|wiccstopcontracurrent|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]
[textarea rows="5"]-Gyn - normal appearance of external genitalia, normal appearance of vaginal mucosa, no abnormal vaginal discharge, no abnormal cervical discharge, no CMT

-Chaperone - ***[/textarea][/conditional]

A/P
[textarea rows="5"]#Contraceptive Management
-reviewed medical history as above
-discussed with patient relevant contraceptive options including indications, benefits, risks 
[/textarea]
[conditional field="wiccfreason" condition="(wiccfreason).is('switching current contraceptive method')"]-Using shared decision-making, will switch contraceptive: [var name="wiccswitchcontracurrent"] >>> [var name="wiccswitchcontradesired"]
[/conditional][conditional field="wiccgender|wiccfreason|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method'))&&((wiccstopcontracurrent).is('Hormone IUD')||(wiccstopcontracurrent).is('Copper IUD'))"][textarea rows="5"]-Using shared decision-making, will stop current contraceptive.
-Device removed. See procedure note.
-Discussed with patient post-device fertility expectations.[/textarea]

[/conditional][conditional field="wiccfreason" condition="(wiccfreason).is('continuing current contraceptive method')"]-Using shared decision-making, will continue current contraceptive: [var name="wicccontinuecontracurrent"]
[/conditional][conditional field="wiccfreason|wicccontinuecontracurrent" condition="(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Pill')"][textarea rows="15"]-Above method prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Assuming no gap: take 1st pill of new pack the day after taking any pill in old pack (regardless of timing of cycle, patient may wait until completion of old pack before starting new pack/contraceptive if desired).
--If >1 day gap between old and new pack, use backup contraception method for 7 days.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]
[/conditional][conditional field="wiccfreason|wicccontinuecontracurrent" condition="(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Patch')"][textarea rows="17"]-Above method prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Option (1) Put on first patch as soon as pack received.
--Option (2) Put on first patch soon after next period begins.
--If first patch put on ≤ 5 days after the start of menses, no backup method needed.
--If first patch put on > 5 days after the start of your period, use back-up method for the first 7 days
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
---patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
---If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]
[/conditional][conditional field="wiccfreason|wicccontinuecontracurrent" condition="(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Ring')"][textarea rows="21"]-Above method prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Option (1) Put in first ring as soon as pack received.
--Option (2) Put in first ring soon after next period begins.
--If first ring put in ≤ 5 days after the start of menses, no backup method needed.
--If first ring put in > 5 days after the start of your period, use back-up method for the first 7 days
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]
[/conditional][conditional field="wiccfreason|wicccontinuecontracurrent" condition="(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin shot')"]-Above method prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate0" default="today"]
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--If >15wk since last injection, use back-up method for the first 7 days following injection.
--If ≤15wk since last injection, no backup method needed.
--Next window: [calc memo="calc value" value="score1=(DepoDate0).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate0).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="lightgray"].
--If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="wiccfreason|wicccontinuecontracurrent" condition="((wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin implant'))||((wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD'))||((wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD'))"][textarea rows="1"]-Device replaced. See procedure note.[/textarea]
[/conditional][conditional field="wiccfreason|wicccontinuecontracurrent" condition="(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')"][textarea rows="30"]--For using external condoms - use a new condom with each intercourse, pull out before penis gets soft wile holding onto the condom's ring, use a polyurethane condom is allergic to latex, 82% effective with proper use
--For using internal condoms - use a new condom with each intercourse, use extra lubrication as needed, 79% effective with proper use
--For using spermicide - insert more spermicide each intercourse, insert spermicide deep into vagina shortly before intercourse, 72% effective with proper use, may use condoms as well (to protect against HIV/STIs, increase effectiveness)
--For using withdrawal/coitus interruptus method - pull penis out of vagina BEFORE ejaculation, does not work if penis not pulled out in time, 78% effective with proper use
--For using fertility awareness/calendar method - predict fertile days by (1) taking temperature daily, (2) checking vaginal mucus for changes, AND/OR (3) keeping a record of menses; works best if using more than one of these methods; avoid intercourse or use condoms/spermicide during fertile days, 76% effective with proper use
--For breastfeeding/lactation amenorrhea method - nurse at least every 4 hours during the day and at least every 6 hours at night, must breastfeed exclusively (not bottles/formula/food), no long considered effective once first menses starts or 6 months after childbirth whichever comes first; 95% effective with proper use
--If using emergency contraception pill method - works best the sooner it is taken after unprotected intercourse, can take pill no more than 5 days after unprotected intercourse, if pack contains 2 pills then take both pills together, can get some brands without prescription, 58-94% effective with proper use[/textarea]
[/conditional][conditional field="wiccfreason" condition="(wiccfreason).is('starting contraceptive method')"]
-Using shared decision-making, will start contraceptive: [var name="wiccstartcontradesired"]
[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Pill'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Pill'))"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Option (1) Take first pill as soon as pill pack received.
--Option (2) Take first pill soon after next period begins.
--If first pill taken ≤ 5 days after the start of menses, no backup method needed.
--If first pill taken > 5 days after the start of your period, use back-up method for the first 7 days
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Patch'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Patch'))"][textarea rows="15"]-Patch prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Option (1) Put on first patch as soon as pack received.
--Option (2) Put on first patch soon after next period begins.
--If first patch put on ≤ 5 days after the start of menses, no backup method needed.
--If first patch put on > 5 days after the start of your period, use back-up method for the first 7 days
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Ring'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Ring'))"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Option (1) Put in first ring as soon as pack received.
--Option (2) Put in first ring soon after next period begins.
--If first ring put in ≤ 5 days after the start of menses, no backup method needed.
--If first ring put in > 5 days after the start of your period, use back-up method for the first 7 days
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Progestin shot'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin shot'))"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate1" default="today"]
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:--Use back-up method for the first 7 days following injection.
--Next window: [calc memo="calc value" value="score1=(DepoDate1).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate1).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Progestin implant'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin implant'))"][textarea rows="5"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Use back-up method for the first 7 days following implant insertion.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"][textarea rows="5"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Use back-up method for the first 7 days following IUD insertion.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"][textarea rows="5"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Copper IUD effective as soon as placed. No period of backup contraception method use needed.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Pill')&&(wiccswitchcontradesired).is('Patch')"][textarea rows="15"]-Patch prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 1 day overlap of old and new methods.
--After placing patch, continue taking pill for 1 day -OR- use backup contraception method for 1 day.
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Pill')&&(wiccswitchcontradesired).is('Ring')"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Assuming no gap in contraception use: no overlap required, insert ring the day after taking any pill in pack.
--If gap and >5 days after start of menses: use backup contraception method for 7 days.
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Pill')&&(wiccswitchcontradesired).is('Progestin shot')"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate2" default="today"]
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 day overlap of old and new methods.
--Continue taking pill for 7 days after getting injection -OR- use backup contraception method for 7 days.
--Next window: [calc memo="calc value" value="score1=(DepoDate2).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate2).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Pill')&&(wiccswitchcontradesired).is('Progestin implant')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 4 day overlap of old and new methods.
--After getting implant inserted, continue taking pill for 4 days after getting implant inserted -OR- use backup contraception method for 4 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Pill')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 day overlap of old and new methods (5 days overlap for switching to Mirena or Liletta).
--After hormone IUD inserted, continue taking pill for 7 days -OR- use backup contraception method for 7 days (5 days for Mirena/Liletta).[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Pill')&&(wiccswitchcontradesired).is('Copper IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--No overlap or backup contraception method needed as long as copper IUD inserted ≤ 5 days after stopping pill.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Patch')&&(wiccswitchcontradesired).is('Pill')"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 1 day overlap of old and new methods.
--After starting pill, keep wearing patch for 1 day after taking first pill -OR- use backup contraception method for 1 day.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Patch')&&(wiccswitchcontradesired).is('Ring')"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Assuming no gap or inserted ≤ 5 days after start of menses: insert ring and remove patch on the same day. No overlap required.
--If gap and >5 days after start of menses, use backup contraception method for 7 days.
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Patch')&&(wiccswitchcontradesired).is('Progestin shot')"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate3" default="today"]
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days overlap of old and new methods.
--After injection, keep wearing patch for 7 days -OR- use backup contraception method for 7 days
--Next window: [calc memo="calc value" value="score1=(DepoDate3).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate3).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Patch')&&(wiccswitchcontradesired).is('Progestin implant')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 4 days overlap between old and new methods.
--After implant insertion, keep wearing patch for 4 days -OR- use backup contraception method for 4 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Patch')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days overlap between old and new methods (5 days overlap for switching to Mirena or Liletta).
--After hormone IUD insertion, keep wearing patch for 7 days -OR- use backup contraception method for 7 days (5 days for Mirena/Liletta).[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Patch')&&(wiccswitchcontradesired).is('Copper IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--No overlap required.
--Have copper IUD inserted ≤ 5 days after removing patch to prevent interruption in contraception coverage.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Pill')"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 1 day of overlap between old and new methods.
--After starting pill, keep in ring for 1 day -OR- use backup contraception method for 1 day.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Patch')"][textarea rows="15"]-Patch prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 2 days of overlap between old and new methods.
--After starting patch, keep in ring for 2 days -OR- use backup contraception method for 2 days.
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Progestin shot')"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate4" default="today"]
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--After injection, keep in ring for 7 days -OR- use backup contraception method for 7 days.
--Next window: [calc memo="calc value" value="score1=(DepoDate4).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate4).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Progestin implant')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 4 days of overlap between old and new methods.
--After implant inserted, keep in ring for 4 days -OR- use backup contraception method for 4 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods (5 days for Mirena/Liletta).
--After IUD insertion, keep in ring for 7 days -OR- use backup contraception method for 7 days (5 days for Mirena/Liletta).[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Copper IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--No overlap required.
--Have copper IUD inserted ≤ 5 days after removing ring to prevent interruption in contraception coverage.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Pill')"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of starting new method ≤ 15 weeks after last injection
--If taking first pill > 15 weeks after last injection BUT ≤ 5 days from start of menses, no backup contraception method required
--If taking first pill > 15 weeks after last injection AND > 5 days from start of menses, use backup contraception method for 7 days.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Patch')"][textarea rows="15"]-Patch  prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of starting new method ≤ 15 weeks after last injection
--If placing first patch > 15 weeks after last injection BUT ≤ 5 days from start of menses, no backup contraception method required
--If placing first patch > 15 weeks after last injection AND > 5 days from start of menses, use backup contraception method for 7 days.
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Ring')"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of starting new method ≤ 15 weeks after last injection
--If inserting ring > 15 weeks after last injection BUT ≤ 5 days from start of menses, no backup contraception method required
--If inserting ring > 15 weeks after last injection AND > 5 days from start of menses, use backup contraception method for 7 days.
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Progestin implant')"][/textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Have implant inserted up to 15 weeks after the last injection.
--If implant inserted > 15 weeks after last injection, use backup contraception method for 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of starting new method ≤ 15 weeks after last injection
--If IUD inserted > 15 weeks after the last injection BUT ≤ 7 days after start of menses, no backup contraception method needed.
--If IUD inserted > 15 weeks after the last injection AND > 7 days after start of menses, use backup contraception method for 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Copper IUD')"][textarea rows="7"]-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:--Goal of Copper IUD insertion ≤ 15 weeks after last injection to avoid interruption in contraception coverage.
--No backup contraception needed after Copper IUD placement.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Pill')"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days overlap between old and new methods.
--After implant removed, continue pill pack for 7 days -OR- use backup contraception method for 7 days.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Patch')"][textarea rows="15"]-Patch prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of overlap of 7 days between old and new methods.
--After impant removed, continue patch for 7 days -OR- use backup contraception method for 7 days.
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Ring')"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of overlap of 7 days between old and new methods.
--After implant removed, continue use of ring for 7 days -OR- use backup contraception method for 7 days.
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Progestin shot')"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate5" default="today"]
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before implant is removed, recommend first injection 7 days prior -OR- use backup contraception method for 7 days after injection.
--Next window: [calc memo="calc value" value="score1=(DepoDate5).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate5).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="7"]-Device inserted. See procedure note.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods (5 days for Mirena/Liletta).
--Before implant removal, insert IUD 7 days prior -OR- use backup contraception for 7 days after IUD insertion (5 days for Mirena/Liletta).[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Copper IUD')"][textarea rows="7"]-Device removed. See procedure note.
-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Have copper IUD inserted ≤ 5 days after implant is removed or use backup contraception until copper IUD inserted. No overlap required.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method'))||((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method'))||((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method'))"][textarea rows="25"]-Device removed. See procedure note.
-Method(s) discussed. 
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--For using external condoms - use a new condom with each intercourse, pull out before penis gets soft wile holding onto the condom's ring, use a polyurethane condom is allergic to latex, 82% effective with proper use
--For using internal condoms - use a new condom with each intercourse, use extra lubrication as needed, 79% effective with proper use
--For using spermicide - insert more spermicide each intercourse, insert spermicide deep into vagina shortly before intercourse, 72% effective with proper use, may use condoms as well (to protect against HIV/STIs, increase effectiveness)
--For using withdrawal/coitus interruptus method - pull penis out of vagina BEFORE ejaculation, does not work if penis not pulled out in time, 78% effective with proper use
--For using fertility awareness/calendar method - predict fertile days by (1) taking temperature daily, (2) checking vaginal mucus for changes, AND/OR (3) keeping a record of menses; works best if using more than one of these methods; avoid intercourse or use condoms/spermicide during fertile days, 76% effective with proper use
--For breastfeeding/lactation amenorrhea method - nurse at least every 4 hours during the day and at least every 6 hours at night, must breastfeed exclusively (not bottles/formula/food), no long considered effective once first menses starts or 6 months after childbirth whichever comes first; 95% effective with proper use
--If using emergency contraception pill method - works best the sooner it is taken after unprotected intercourse, can take pill no more than 5 days after unprotected intercourse, if pack contains 2 pills then take both pills together, can get some brands without prescription, 58-94% effective with proper use[/textarea]
[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Pill')"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before IUD removal, Start pill pack 7 days prior -OR- use backup contraception method for 7 days after starting pill pack.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Patch')"][textarea rows="15"]-Patch prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before IUD removal, place patch 7 days prior -OR- use backup contraception method for 7 days after placing patch.
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Ring')"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before IUD removal, insert ring 7 days prior -OR- use backup contraception method for 7 days after insertion of ring.
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Progestin shot')"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate6" default="today"]
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before IUD removal, Have first injection 7 days prior -OR- use backup contraception method for 7 days after injection.
--Next window: [calc memo="calc value" value="score1=(DepoDate6).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate6).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Progestin implant')"][textarea rows="7"]-Device removed. See procedure note.
-Device placed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 4 days of overlap between old and new methods.
--Before IUD removal, insert implant 4 days prior -OR- use backup contraception method for 4 days after insertion of implant.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="7"]-Device replaced. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--No overlap required between these methods of contraception.
--No backup contraception method needed.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')"][textarea rows="5"]-Device replaced. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Have copper IUD inserted right after hormone IUD is removed. No overlap required.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="5"]-Device replaced. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Have hormone IUD inserted right after copper IUD is removed. No overlap required.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Pill')"][textarea rows="15"]-Pill prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before Copper IUD removal, start pill pack 7 days prior -OR- use backup contraception method for 7 days after starting pill pack.
--Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
--After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
--If missed ONE pill: Take pill as soon as possible.
--If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Patch')"][textarea rows="15"]-Patch prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before Copper IUD removal, place patch 7 days prior -OR- use backup contraception method for 7 days after placing patch.
--Use new patch every week for 3 weeks and no patch for the 4th week.
--Expect menses during the patch-free week. May have a light menses or no menses at all.
--Start a new box of patches at the end of the 4th week.
--If the patch comes off, put it back on right away. If it does not stick, use a new patch.
--If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
--If forgot to change patch after 7 days:
--patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
--If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Ring')"][textarea rows="15"]-Vaginal ring prescribed and patient to pickup in pharmacy.
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before Copper IUD removal, insert ring 7 days prior -OR- use backup contraception method for 7 days after inserting ring.
--If first ring put in ≤ 5 days after the start of menses, no backup method needed.
--If first ring put in > 5 days after the start of your period, use back-up method for the first 7 days
--Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
--Ring is removed by hooking a finger under the rim and pulling it out.
--Most women have menses during the ring-free week.
--Insert a new ring at the end of the 4th week.
--Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
--If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
--If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Progestin shot')"]-Progestin IM injection prescribed/ordered.
-Date estimated/anticipated given: [date name="DepoDate7" default="today"]
-Device removed. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 7 days of overlap between old and new methods.
--Before Copper IUD removal, have first injection 7 days prior -OR- use backup contraception method for 7 days after first injection.
--Next window: [calc memo="calc value" value="score1=(DepoDate7).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate7).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
--If miss window for next injection, will need pregnancy test prior to injection.

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Progestin implant')"][textarea rows="7"]-Device removed. See procedure note.
-Device placed. See procedure note
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--Goal of 4 days of overlap between old and new methods.
--Before Copper IUD removal, insert implant 4 days prior -OR- use backup contraception method for 4 days after insertion of implant.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="(wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')"][textarea rows="8"]-Device replaced. See procedure note.
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--When Copper IUD removed:
---If Kyleena/Skyla, insert hormone IUD right after AND use back-up method for 7 days.
---If Mirena/Liletta, insert hormone IUD right after. No backup contraception method needed in this case. If not inserted right after copper IUD removal, use back-up contraception method for 7 days.[/textarea]

[/conditional][conditional field="wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Ring')&&(wiccswitchcontradesired).is('Ring'))||((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin shot')&&(wiccswitchcontradesired).is('Progestin shot'))||((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).is('Progestin implant'))||((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccfreason).is('switching current contraceptive method')&& (wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD'))"]--Please select two different methods. 

[/conditional][conditional field="wiccfreason|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method'))||((wiccstartcontradesired).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method'))"][textarea rows="25"]-Method(s) discussed. 
-Recommended following course(s) of action to minimize gaps in contraception coverage and unintended pregnancy:
--For using external condoms - use a new condom with each intercourse, pull out before penis gets soft wile holding onto the condom's ring, use a polyurethane condom is allergic to latex, 82% effective with proper use
--For using internal condoms - use a new condom with each intercourse, use extra lubrication as needed, 79% effective with proper use
--For using spermicide - insert more spermicide each intercourse, insert spermicide deep into vagina shortly before intercourse, 72% effective with proper use, may use condoms as well (to protect against HIV/STIs, increase effectiveness)
--For using withdrawal/coitus interruptus method - pull penis out of vagina BEFORE ejaculation, does not work if penis not pulled out in time, 78% effective with proper use
--For using fertility awareness/calendar method - predict fertile days by (1) taking temperature daily, (2) checking vaginal mucus for changes, AND/OR (3) keeping a record of menses; works best if using more than one of these methods; avoid intercourse or use condoms/spermicide during fertile days, 76% effective with proper use
--For breastfeeding/lactation amenorrhea method - nurse at least every 4 hours during the day and at least every 6 hours at night, must breastfeed exclusively (not bottles/formula/food), no long considered effective once first menses starts or 6 months after childbirth whichever comes first; 95% effective with proper use
--If using emergency contraception pill method - works best the sooner it is taken after unprotected intercourse, can take pill no more than 5 days after unprotected intercourse, if pack contains 2 pills then take both pills together, can get some brands without prescription, 58-94% effective with proper use[/textarea]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]IUD INSERTION PROCEDURE NOTE
[comment memo="use both dx codes:
Z30.014 Encounter for initial prescription of IUD (includes initial rx of IUD, couseling, advice, excludes IUD insertion)
Z30.430 Encounter for insertion of IUD

" memo_size="small" memo_color="lightgray"][checkbox name="IUDinsSup" value="Supervising Physician:" memo="if applicable" memo_size="small" memo_color="whitesmoke"][/conditional][conditional field="IUDinsSup" condition="(IUDinsSup).is('Supervising Physician:')"] Dr. [text size="40"]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"][comment memo="

" memo_size="small" memo_color="whitesmoke"]PROCEDURE: Insertion of IUD - CPT 58300
IUD Type: [/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"][select name="hormoneIUDtypeinserted" memo="*" memo_size="small" memo_color="blue" value="Mirena|Kyleena|Skyla|Liletta"][/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"][select name="copperIUDtypeinserted" memo="*" memo_size="small" memo_color="blue" value="Paragard/Copper IUD"][/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]
IUD Lot#: [text size="20"]

INDICATIONS/COUNSELING/CONSENT - [select memo="*" memo_color="blue" memo_size="small" name="hormoneIUDinsconsenttype" value="written|verbal"]
-Indication(s): see HPI
-The patient was counseled regarding the risks, benefits and alternatives of IUD insertion and use.
-She is aware that there are other methods of contraception such as OCPs, contraceptive patches and rings and barrier methods of contraception.
-She was informed that the failure rate is about one woman for every 1000 women who use the IUD for one year.
-If she should become pregnant, the risk of ectopic or tubal pregnancy is about 50%.
-If she ever has symptoms of pregnancy, she should have a pregnancy test immediately as tubal pregnancies can be life threatening.
-Complications following insertion of an IUD are rare.
-There is a small possibility that the instrument used to measure the uterus or the IUD itself could perforate the wall of the uterus. This might not be obvious immediately.
-If she experiences symptoms of infection such as pain, fever >100.4, chills, painful intercourse, nausea and vomiting, prolonged bleeding or foul smelling discharge, she should be seen in clinic.
-In the rare event that an IUD has passed through the wall of the uterus into the abdomen, it will need to be removed surgically. In extreme cases, the IUD may cause scarring which could lead to the need for a hysterectomy (surgery to remove the uterus) and the inability to have children.
-She was advised to check her string after each menstrual cycle or at least monthly and to make an appointment with her provider immediately if she is not able to find the strings, suspects she is pregnant or experiences any of the symptoms mentioned above.
-Confirmed that all of her questions were answered and she desires to proceed with the IUD insertion.
[/conditional][conditional field="hormoneIUDinsconsenttype|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((hormoneIUDinsconsenttype).is('verbal')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDinsconsenttype).is('verbal')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDinsconsenttype).is('verbal')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||||((hormoneIUDinsconsenttype).is('verbal')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"][comment memo="
" memo_color="whitesmoke" memo_size="small"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="hormoneIUDinsconsenttype|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((hormoneIUDinsconsenttype).is('written')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDinsconsenttype).is('written')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDinsconsenttype).is('written')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((hormoneIUDinsconsenttype).is('written')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"][checkbox value=" -Patient was identified using full name and DOB.
-Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
-Procedure type matches the consent form.
-For final timeout, physician paused or verbally confirmed with procedure team of:
 -Correct patient, and correct procedure.
 -Patient has been positioned correctly for the procedure.
 -All necessary equipment are available.
 -Instrument sterility verified.
"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
PROCEDURE DETAILS:
[checkbox name="bimanualhormonalIUDins" value="-Bimanual exam was performed and position of uterus determined to be "][comment memo="
" memo_color="whitesmoke" memo_size="small"][/conditional][conditional field="bimanualhormonalIUDins" condition="(bimanualhormonalIUDins).is('-Bimanual exam was performed and position of uterus determined to be ')"][select value="anteroverted.|midposition.|posteroverted."]
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]-The speculum was inserted and the cervix was identified.
-[select value="Betadine|Chlorhexidine"] was used to clean the cervix.
[checkbox value="-An os dilator was used.
"][comment memo="
" memo_color="whitesmoke" memo_size="small"][checkbox value="-A sound was used.
"][comment memo="
" memo_color="whitesmoke" memo_size="small"]-Uterus sounded to a depth of [text size="5"] cm.
[checkbox name="hormonetenaculum1" value="-A tenaculum was applied to "][comment memo="
" memo_color="whitesmoke" memo_size="small"][/conditional][conditional field="hormonetenaculum1" condition="(hormonetenaculum1).is('-A tenaculum was applied to ')"][select value="superior/anterior cervix. |posterior/inferior cervix."]
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"]-[var name="hormoneIUDtypeinserted"] was [/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]-[var name="copperIUDtypeinserted"] was [/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"][select name="hormoneIUDsuccess1" value="successfully|unsuccessfully"] inserted per manufacturer protocol.
[/conditional][conditional field="hormoneIUDsuccess1|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))||((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]-The string was cut to a 3 centimeters length and a sample of the remaining string was given to the patient for later comparison.
[comment memo="
" memo_color="whitesmoke" memo_size="small"]-Date inserted: [date name="hormoneIUDinsDate1" default="today"]
[/conditional][conditional field="hormoneIUDtypeinserted|hormoneIUDsuccess1|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((hormoneIUDtypeinserted).is('Mirena')&&(hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDtypeinserted).is('Mirena')&&(hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"]-Effective for contraception for 8 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(hormoneIUDinsDate1).dateAdd(2920)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="copperIUDtypeinserted|hormoneIUDsuccess1|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((copperIUDtypeinserted).is('Paragard/Copper IUD')&&(hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((copperIUDtypeinserted).is('Paragard/Copper IUD')&&(hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Copper IUD'))"]-Effective for contraception for 10 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(hormoneIUDinsDate1).dateAdd(3650)"]
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="hormoneIUDtypeinserted|hormoneIUDsuccess1" condition="(hormoneIUDtypeinserted).is('Kyleena')&&(hormoneIUDsuccess1).is('successfully')"]-Effective for contraception for 5 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(hormoneIUDinsDate1).dateAdd(1825)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="hormoneIUDtypeinserted|hormoneIUDsuccess1" condition="(hormoneIUDtypeinserted).is('Skyla')&&(hormoneIUDsuccess1).is('successfully')"]-Effective for contraception for 3 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(hormoneIUDinsDate1).dateAdd(1095)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="hormoneIUDtypeinserted|hormoneIUDsuccess1" condition="(hormoneIUDtypeinserted).is('Liletta')&&(hormoneIUDsuccess1).is('successfully')"]-Effective for contraception for 6 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(hormoneIUDinsDate1).dateAdd(2190)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="hormoneIUDsuccess1|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDsuccess1).is('successfully')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"]
[textarea rows="10"]PATIENT DISPOSITION
-EBL less than 5 ml.
-The patient tolerated the procedure well, without any S/S of vasovagal responses or other immediate procedural complications.
-Gave return precautions: fever, severe lower abdominal cramping, heavy bleeding, or purulent discharge.
-The patient was counseled to check the strings herself monthly to ensure the IUD has not been displaced.
-Patient left in stable condition with appropriate counseling as described above.[/textarea][/conditional][conditional field="hormoneIUDsuccess1|wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((hormoneIUDsuccess1).is('unsuccessfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Hormone IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDsuccess1).is('unsuccessfully')&&(wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Copper IUD')&&(wiccswitchcontracurrent).isNot('Copper IUD')&&(wiccswitchcontracurrent).isNot('Hormone IUD'))||((hormoneIUDsuccess1).is('unsuccessfully')&&(wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Hormone IUD'))"][textarea rows="10"]-Despite unsuccessful insertion, patient tolerated the procedure well, without any immediate concerning complications noted. Next steps were discussed with patient including followup. Patient was referred to Gynecologist. Patient acknowledged understanding and intent to followup as discussed/planned.[/textarea]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD'))"]IUD REMOVAL PROCEDURE NOTE
[comment memo="use dx code Z30.432 Encounter for removal of IUD

" memo_size="small" memo_color="lightgray"][checkbox name="IUDremovSup" value="Supervising Physician:" memo="if applicable" memo_size="small" memo_color="whitesmoke"][/conditional][conditional field="IUDremovSup" condition="(IUDremovSup).is('Supervising Physician:')"] Dr. [text size="40"]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD'))"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
PROCEDURE: Removal of IUD - CPT 58301
IUD Type removed: [select name="IUDtyperemoved" memo="*" memo_size="small" memo_color="blue" value="Hormone IUD|Paragard/Copper IUD"]

INDICATIONS/COUNSELING/CONSENT - [select memo="*" memo_color="blue" memo_size="small" name="IUDremovconsenttype" value="verbal|written"]:
-Indication(s): see HPI
-Confirmed patient aware of ability to get pregnant once removed if this IUD form of contraception not replaced or appropriately transitioned to another form of contraception.
-Confirmed that patient has plan in place for alternate form of contraception if not desiring to get pregnant
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent|IUDremovconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(IUDremovconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(IUDremovconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD')&&(IUDremovconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD')&&(IUDremovconsenttype).is('verbal'))"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="not required/indicated per clinic protocol/policy|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent|IUDremovconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(IUDremovconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(IUDremovconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD')&&(IUDremovconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD')&&(IUDremovconsenttype).is('written'))"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD'))"][comment memo="timeout
" memo_size="small"][checkbox value=" -Patient was identified using full name and DOB.
-Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
-Procedure type matches the consent form.
-For final timeout, physician paused or verbally confirmed with procedure team of:
 -Correct patient, and correct procedure.
 -Patient has been positioned correctly for the procedure.
 -All necessary equipment are available.
 -Instrument sterility verified.
"][comment memo="
" memo_color="whitesmoke" memo_size="small"]
PROCEDURE DETAILS:
-The speculum was inserted and the cervix was identified.
-The IUD strings were: [select name="IUDstrings1" value="identified|not identified"][/conditional]

[conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent|IUDstrings1" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(IUDstrings1).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(IUDstrings1).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD')&&(IUDstrings1).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD')&&(IUDstrings1).is('identified'))"] and grasped with a Kelly clamp.
-With gentle traction, the IUD was [select name="IUDtraction1" value="removed.|unable to be removed."][/conditional][conditional field="IUDtraction1" condition="(IUDtraction1).is('unable to be removed.')"]
-The following actions were taken: [checkbox value="Patient referred to Gynecologist for assistance with extraction|Pelvic ultrasound was ordered to confirm location of IUD"][textarea memo="add'l actions taken" memo_size="small" memo_color="orange"][comment memo="
" memo_color="whitesmoke" memo_size="small"][/conditional][conditional field="IUDstrings1" condition="(IUDstrings1).is('not identified')"].
-Attempted visualization & retrieval of strings with use the following: [checkbox value="cytobrush|IUD hook|endocervical speculum"]
-Retrieval was ultimately [select name="cytobrushretrieval1" value="successful.|unsuccessful."]
[/conditional][conditional field="IUDstrings1|cytobrushretrieval1" condition="(IUDstrings1).is('not identified')&&(cytobrushretrieval1).is('successful.')"] -Strings were grasped with a Kelly clamp.
-With gentle traction, the IUD was [select name="IUDtraction2" value="removed.|unable to be removed."]
[/conditional][conditional field="IUDtraction2|cytobrushretrieval1" condition="(IUDtraction2).is('unable to be removed.')||(cytobrushretrieval1).is('unsuccessful.')"]-The following actions were taken: [checkbox value="Patient referred to Gynecologist for assistance with extraction|Pelvic ultrasound was ordered to confirm location of IUD|other-"][textarea memo="add'l actions taken" memo_size="small" memo_color="orange"]
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).isNot('Copper IUD')&&(wiccswitchcontradesired).isNot('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Copper IUD'))"]

[textarea rows="7"]PATIENT DISPOSITION
-EBL was <5ml.
-The patient tolerated the procedure well, without any S/S of vasovagal responses or other immediate procedural complications.
-Patient left in stable condition with appropriate counseling as described above.[/textarea]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD'))"]IUD REMOVAL & REINSERTION PROCEDURE NOTE
[comment memo="use dx code Z30.433 for removal/reinsertion of IUD
" memo_size="small" memo_color="gray"]
[checkbox name="IUDreinsSup" value="Supervising Physician:" memo="if applicable" memo_size="small" memo_color="whitesmoke"][/conditional][conditional field="IUDreinsSup" condition="(IUDreinsSup).is('Supervising Physician:')"] Dr. [text size="40"]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD'))"][comment memo="

" memo_color="whitesmoke" memo_size="small"]PROCEDURE:
-Removal of IUD - CPT 58301
-Insertion of IUD - CPT 58300 - [select name="IUDreinstypeinserted" memo="*" memo_size="small" memo_color="blue" value="Mirena|Kyleena|Skyla|Liletta|Paragard/Copper IUD"]
IUD Lot#: [text size="20"]

INDICATIONS/COUNSELING/CONSENT - [select memo="*" memo_color="blue" memo_size="small" name="IUDreinsconsenttype" value="written|verbal"]
-Confirmed patient desires removal of IUD due to current IUD needing replacement and patient continues to desire long-term contraception.
-Indication(s): see HPI
-The patient was counseled regarding the risks, benefits and alternatives of IUD insertion and use.
-She is aware that there are other methods of contraception such as OCPs, contraceptive patches and rings and barrier methods of contraception.
-She was informed that the failure rate is about one woman for every 1000 women who use the IUD for one year.
-If she should become pregnant, the risk of ectopic or tubal pregnancy is about 50%.
-If she ever has symptoms of pregnancy, she should have a pregnancy test immediately as tubal pregnancies can be life threatening.
-Complications following insertion of an IUD are rare.
-There is a small possibility that the instrument used to measure the uterus or the IUD itself could perforate the wall of the uterus. This might not be obvious immediately.
-If she experiences symptoms of infection such as pain, fever >100.4, chills, painful intercourse, nausea and vomiting, prolonged bleeding or foul smelling discharge, she should be seen in clinic.
-In the rare event that an IUD has passed through the wall of the uterus into the abdomen, it will need to be removed surgically. In extreme cases, the IUD may cause scarring which could lead to the need for a hysterectomy (surgery to remove the uterus) and the inability to have children.
-She was advised to check her string after each menstrual cycle or at least monthly and to make an appointment with her provider immediately if she is not able to find the strings, suspects she is pregnant or experiences any of the symptoms mentioned above.
-Confirmed that all of her questions were answered and she desires to proceed with the IUD reinsertion.
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDreinsconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinsconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDreinsconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDreinsconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinsconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDreinsconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDreinsconsenttype).is('verbal'))"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDreinsconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinsconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDreinsconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDreinsconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinsconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDreinsconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDreinsconsenttype).is('written'))"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD'))"][comment memo="timeout
" memo_size="small"][checkbox value=" -Patient was identified using full name and DOB.
 -Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure type matches the consent form.
 -For final timeout, physician paused or verbally confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side.
  -The patient has been positioned correctly for the procedure.
  -All necessary equipment are available
  -Instrument sterility verified.
"][comment memo="
" memo_color="whitesmoke" memo_size="small"]
PROCEDURE DETAILS:
[checkbox name="bimanualIUDreins" value="-Bimanual exam was performed and position of uterus determined to be "][comment memo="
" memo_color="whitesmoke" memo_size="small"][/conditional][conditional field="bimanualIUDreins" condition="(bimanualIUDreins).is('-Bimanual exam was performed and position of uterus determined to be ')"][select value="anteroverted.|midposition.|posteroverted."]
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD'))"]-The speculum was inserted and the cervix was identified.
-The IUD strings were: [select name="IUDstrings2" value="identified|not identified"][/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDstrings2" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('identified'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('identified'))"] and grasped with a Kelly clamp.
-With gentle traction, the IUD was [select name="IUDtraction3" value="removed.|unable to be removed."]
[/conditional][conditional field="IUDtraction3" condition="(IUDtraction3).is('unable to be removed.')"]
-The following actions were taken: [checkbox value="Patient referred to Gynecologist for assistance with extraction|Pelvic ultrasound was ordered to confirm location of IUD|other-"][textarea memo="add'l actions taken" memo_size="small" memo_color="orange"][/conditional][conditional field="IUDstrings2" condition="(IUDstrings2).is('not identified')"].
-Attempted visualization & retrieval of strings with use the following: [checkbox value="cytobrush|IUD hook|endocervical speculum"]
-Retrieval was ultimately [select name="cytobrushretrieval2" value="successful.|unsuccessful."][/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDstrings2|cytobrushretrieval2" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.'))"]
-Strings were grasped with a Kelly clamp.
-With gentle traction, the IUD was [select name="IUDtraction4" value="removed.|unable to be removed."]
[/conditional][conditional field="IUDtraction4|cytobrushretrieval2" condition="(IUDtraction4).is('unable to be removed.')||(cytobrushretrieval2).is('unsuccessful.')"]-The following actions were taken: [checkbox value="Patient referred to Gynecologist for assistance with extraction|Pelvic ultrasound was ordered to confirm location of IUD|other-"][textarea memo="add'l actions taken" memo_size="small" memo_color="orange"]
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDstrings2|cytobrushretrieval2|IUDtraction3|IUDtraction4" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))"]-[select value="Betadine|Chlorhexidine"] was used to clean the cervix.
[checkbox value="-An os dilator was used.
"][comment memo="
" memo_color="whitesmoke" memo_size="small"][checkbox value="-A sound was used.
"][comment memo="
" memo_color="whitesmoke" memo_size="small"]-Uterus sounded to a depth of [text size="5"] cm.
-[select memo="choose" memo_size="small" name="tenaculum2" value="A tenaculum was not used. |A tenaculum was applied to "][/conditional][conditional field="tenaculum2" condition="(tenaculum2).is('A tenaculum was applied to ')"][select value="superior/anterior cervix. |posterior/inferior cervix. "][/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDstrings2|cytobrushretrieval2|IUDtraction3|IUDtraction4" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))"]
-[var name="IUDreinstypeinserted"] was inserted per manufacturer protocol.
-The string was cut to a 3 centimeters length and a sample of the remaining string was given to the patient for later comparison.
[comment memo="
" memo_color="whitesmoke" memo_size="small"]-Date inserted: [date name="IUDreinsDate1" default="today"]
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDreinstypeinserted|IUDstrings2|cytobrushretrieval2|IUDtraction3|IUDtraction4" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinstypeinserted).is('Mirena')&&(IUDstrings2).is('identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinstypeinserted).is('Mirena')&&(IUDstrings2).is('identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinstypeinserted).is('Mirena')&&(IUDstrings2).is('identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDreinstypeinserted).is('Mirena')&&(IUDstrings2).is('identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDreinstypeinserted).is('Mirena')&&(IUDstrings2).is('identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDreinstypeinserted).is('Mirena')&&(IUDstrings2).is('identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))"]-Effective for contraception for 8 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(IUDreinsDate1).dateAdd(2920)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="IUDreinstypeinserted" condition="(IUDreinstypeinserted).is('Kyleena')"]-Effective for contraception for 5 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(IUDreinsDate1).dateAdd(1825)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="IUDreinstypeinserted" condition="(IUDreinstypeinserted).is('Skyla')"]-Effective for contraception for 3 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(IUDreinsDate1).dateAdd(1095)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="IUDreinstypeinserted" condition="(IUDreinstypeinserted).is('Liletta')"]-Effective for contraception for 6 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(IUDreinsDate1).dateAdd(1825)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="IUDreinstypeinserted" condition="(IUDreinstypeinserted).is('Paragard/Copper IUD')"]-Effective for contraception for 10 years
-Latest recommended date to be replaced to prevent gap in coverage per FDA approved duration: [calc memo="calc value" value="score1=(IUDreinsDate1).dateAdd(3650)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent|IUDstrings2|cytobrushretrieval2|IUDtraction3|IUDtraction4" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Copper IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Hormone IUD')&&(wiccswitchcontradesired).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Hormone IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('identified')&&(IUDtraction3).is('removed.'))||((wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Copper IUD')&&(IUDstrings2).is('not identified')&&(cytobrushretrieval2).is('successful.')&&(IUDtraction4).is('removed.'))"]
[textarea rows="10"]PATIENT DISPOSITION
-EBL less than 5 ml.
-The patient tolerated the procedure well, without any S/S of vasovagal responses or other immediate procedural complications.
-Gave return precautions: fever, severe lower abdominal cramping, heavy bleeding, or purulent discharge.
-The patient was counseled to check the strings herself monthly to ensure the IUD has not been displaced.[/textarea][/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Progestin implant')&&(wiccswitchcontracurrent).isNot('Progestin implant'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin implant'))"]NEXPLANON INSERTION PROCEDURE NOTE
[comment memo="use dx code Z30.017 for initial prescription of implantable subdermal contraceptive
" memo_size="small" memo_color="gray"]
[checkbox name="NexplanonInsSup" value="Supervising Physician:" memo="if applicable" memo_size="small" memo_color="whitesmoke"][/conditional][conditional field="NexplanonInsSup" condition="(NexplanonInsSup).is('Supervising Physician:')"] Dr. [text size="40"]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Progestin implant')&&(wiccswitchcontracurrent).isNot('Progestin implant'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin implant'))"][comment memo="

" memo_size="small" memo_color="whitesmoke"]PROCEDURE: Insertion of Nexplanon - CPT 11981
Device Lot#: [text size="20"]
Anesthesia Agent(s): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml

INDICATIONS/COUNSELING/CONSENT - [select memo="*" memo_color="blue" memo_size="small" name="nexplanoninsconsenttype" value="written|verbal"]
-Indication(s): see HPI
-The patient was counseled regarding the risks, benefits and alternatives of Nexplanon insertion and use.
-She is aware that there are other methods of contraception such as OCPs, contraceptive patches and rings and barrier methods of contraception.
-Discussed and patient verbalized understanding of the risks, benefits, alternatives and possible complications of subdermal implants to include:
-possible contraindications include known or suspected pregnancy, current or past history of thrombosis, liver disease, undiagnosed abnormal genital bleeding, current or past history of breast cancer, allergic reaction to any components of the Nexplanon device.
-potential changes in menstrual bleeding pattern including 22% amenorrhea, 18% prolonged bleeding, 7% frequent bleeding, 34% infrequent bleeding.
-possible adverse effects including ectopic pregnancy, thrombotic events or liver disease, depression or emotional lability, headache, weight increase.
-Nexplanon may be used for nursing after the 4th week.
-Confirmed that all of her questions were answered and she desires to proceed with the Nexplanon insertion.
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired|nexplanoninsconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Progestin implant')&&(wiccswitchcontracurrent).isNot('Progestin implant')&&(nexplanoninsconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin implant')&&(nexplanoninsconsenttype).is('verbal'))"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired|nexplanoninsconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Progestin implant')&&(wiccswitchcontracurrent).isNot('Progestin implant')&&(nexplanoninsconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin implant')&&(nexplanoninsconsenttype).is('written'))"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstartcontradesired" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontradesired).is('Progestin implant')&&(wiccswitchcontracurrent).isNot('Progestin implant'))||((wiccgender).is('F')&&(wiccfreason).is('starting contraceptive method')&&(wiccstartcontradesired).is('Progestin implant'))"][comment memo="timeout
" memo_size="small"][checkbox value=" -Patient identified using full name and DOB.
 -Patient evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
 -Confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side.
  -The patient has been positioned correctly for the procedure.
  -All necessary equipment are available.
  -Instrument sterility verified."]

PROCEDURE DETAILS:
-[select value="Left|Right"] arm landmarks identified and insertion site and guiding site marked with [select value="tissue marker|retracted tip of pen"] per manufacturer's recommendations.
-Area cleansed with [select value="Betadine/Iodine|Chlorhexidine"] and adequate drying time allowed per manufacturer recommendations and infection control protocol.
-Above anesthetic agent was injected with 27g needle under the skin of the identified insertion point and along the insertion canal.
-In sterile fashion applicator was inspected and presence of Nexplanon device verified.
-Applicator used to insert Nexplanon device.
-Grooved tip of obturator was visible inside needle upon removal.
-Both myself and patient palpated the Nexplanon device in subdermal location.
-The site was dressed with [checkbox value="Dermabond|SteriStrips|pressure dressing|bacitracin ointment"].
-Hemostasis assured.
-Date placed: [date name="NexplanonInsDate" default="today"]
-Effective for contraception for 3 years, latest recommended date to be replaced to avoid gap in coverage: [calc memo="calc value" value="score1=(NexplanonInsDate).dateAdd(1095)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.

[textarea rows="10"]PATIENT DISPOSITION
-EBL < 1ml.
-Wound care instructions reviewed.
-Discussed return precautions to include:
 -bleeding at insertion site that is continuing to soak through pads after first removed
 -worsening pain after first 24 hours
 -increasing swelling after first 24 hours
 -pus coming from insertion site
 -fever[/textarea]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).isNot('Progestin implant'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Progestin implant'))"]NEXPLANON REMOVAL PROCEDURE NOTE
[comment memo="use dx code Z30.46 for removal of implantable subdermal contraceptive
" memo_size="small" memo_color="gray"]
[checkbox name="NexplanonRemovSup" value="Supervising Physician:" memo="if applicable" memo_size="small" memo_color="whitesmoke"][/conditional][conditional field="NexplanonRemovSup" condition="(NexplanonRemovSup).is('Supervising Physician:')"] Dr. [text size="40"]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).isNot('Progestin implant'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Progestin implant'))"][comment memo="

" memo_size="small" memo_color="whitesmoke"]PROCEDURE: Removal of nexplanon - CPT 11982
Anesthesia Agent(s): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml

INDICATIONS/COUNSELING/CONSENT - [select memo="*" memo_color="blue" memo_size="small" name="nexplanonremovconsenttype" value="written|verbal"]
-Indication(s): see HPI
-Confirmed patient aware of ability to get pregnant once removed if this Nexplanon device not replaced or appropriately transitioned to another form of contraception.
-Confirmed that patient has plan in place for alternate form of contraception if not desiring to get pregnant
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent|nexplanonremovconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).isNot('Progestin implant')&&(nexplanonremovconsenttype).is('verbal'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Progestin implant')&&(nexplanonremovconsenttype).is('verbal'))"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent|nexplanonremovconsenttype" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).isNot('Progestin implant')&&(nexplanonremovconsenttype).is('written'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Progestin implant')&&(nexplanonremovconsenttype).is('written'))"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wiccstopcontracurrent" condition="((wiccgender).is('F')&&(wiccfreason).is('switching current contraceptive method')&&(wiccswitchcontracurrent).is('Progestin implant')&&(wiccswitchcontradesired).isNot('Progestin implant'))||((wiccgender).is('F')&&(wiccfreason).is('stopping current contraceptive method')&&(wiccstopcontracurrent).is('Progestin implant'))"][comment memo="timeout
" memo_size="small"][checkbox value=" -Patient identified using full name and DOB.
 -Patient evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
 -Confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side.
  -The patient has been positioned correctly for the procedure.
  -All necessary equipment are available.
  -Instrument sterility verified.
"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
PROCEDURE DETAILS:
-Device was palpated, distal end identified, and guiding site marked with [select value="tissue marker|retracted tip of pen"]
-The area surrounding the Nexplanon was cleansed with [select value="Betadine/Iodine|Chlorhexidine"] and adequate drying time allowed per manufacturer recommendations and infection control protocol.
-Above anesthetic agent was injected with 27g needle through the skin enough to form a very small wheal and the remainder under the distal aspect of the device.
-Using [select value="#11blade|#15blade"] scalpel, a skin incision was made over the distal aspect of the device.
-The tissue capsule surrounding the device was lysed sharply and the device removed using a hemostat.
-Hemostasis was assured.
-The site was dressed with [checkbox value="Dermabond|SteriStrips|pressure dressing|bacitracin ointment"].

[textarea rows="10"]PATIENT DISPOSITION
-EBL < 1ml.
-Wound care instructions reviewed.
-Discussed return precautions to include: 
 -bleeding at removal site that is continuing to soak through pads after first removed
 -worsening pain after first 24 hours|increasing swelling after first 24 hours
 -pus coming from insertion site
 -fever[/textarea]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin implant')"]NEXPLANON REMOVAL/REINSERTION PROCEDURE NOTE
[comment memo="use dx code Z30.46 for removal/reinsertion of implantable subdermal contraceptive
" memo_size="small" memo_color="gray"]
[checkbox name="NexplanonReinsSup" value="Supervising Physician:" memo="if applicable" memo_size="small" memo_color="whitesmoke"][/conditional][conditional field="NexplanonReinsSup" condition="(NexplanonReinsSup).is('Supervising Physician:')"] Dr. [text size="40"]

[/conditional][conditional field="wiccgender|wiccfreason|wiccswitchcontracurrent|wiccswitchcontradesired|wicccontinuecontracurrent" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin implant')"][comment memo="
" memo_size="small" memo_color="whitesmoke"]PROCEDURE: Removal with reinsertion of nexplanon - CPT 11983
Device Lot#: [text size="20"]
Anesthesia Agent(s): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml

INDICATIONS/COUNSELING/CONSENT - [select memo="*" memo_color="blue" memo_size="small" name="nexplanonreinsconsenttype" value="written|verbal"]
-Confirmed patient desires removal/reinsertion of Nexplanon for the following reason(s): [select value="current Nexplanon needs replaced|other"]. [text memo="add'l explanation if needed" memo_size="small" size="50"]
-Indication(s): see HPI
-The patient was counseled regarding the risks, benefits and alternatives of Nexplanon insertion and use.
-She is aware that there are other methods of contraception such as OCPs, contraceptive patches and rings and barrier methods of contraception.
-Discussed and patient verbalized understanding of the risks, benefits, alternatives and possible complications of subdermal implants to include:
-possible contraindications include known or suspected pregnancy, current or past history of thrombosis, liver disease, undiagnosed abnormal genital bleeding, current or past history of breast cancer, allergic reaction to any components of the Nexplanon device.
-potential changes in menstrual bleeding pattern including 22% amenorrhea, 18% prolonged bleeding, 7% frequent bleeding, 34% infrequent bleeding.
-possible adverse effects including ectopic pregnancy, thrombotic events or liver disease, depression or emotional lability, headache, weight increase.
-Nexplanon may be used for nursing after the 4th week.
-Confirmed that all of her questions were answered and she desires to proceed with the Nexplanon reinsertion.
[/conditional][conditional field="wiccgender|wiccfreason|wicccontinuecontracurrent|nexplanonreinsconsenttype" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin implant')&&(nexplanonreinsconsenttype).is('verbal')"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wicccontinuecontracurrent|nexplanonreinsconsenttype" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin implant')&&(nexplanonreinsconsenttype).is('written')"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="wiccgender|wiccfreason|wicccontinuecontracurrent" condition="(wiccgender).is('F')&&(wiccfreason).is('continuing current contraceptive method')&&(wicccontinuecontracurrent).is('Progestin implant')"][comment memo="timeout
" memo_size="small"][checkbox value=" -Patient identified using full name and DOB.
 -Patient evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
 -Confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side.
  -The patient has been positioned correctly for the procedure.
  -All necessary equipment are available.
  -Instrument sterility verified.
"][comment memo="
" memo_size="small" memo_color="whitesmoke"]
PROCEDURE DETAILS:
-Device was palpated, distal end identified, and guiding site marked with [select value="tissue marker|retracted tip of pen"]
-The area surrounding the Nexplanon was cleansed with [select value="Betadine/Iodine|Chlorhexidine"] and adequate drying time allowed per manufacturer recommendations and infection control protocol.
-Above anesthetic agent was injected with 27g needle through the skin enough to form a very small wheal and the remainder under the distal aspect of the device.
-Using [select value="#11blade|#15blade"] scalpel, a skin incision was made over the distal aspect of the device.
-The tissue capsule surrounding the device was lysed sharply and the device removed using a hemostat.
-In sterile fashion applicator for replacement Nexplanon device was inspected and presence of Nexplanon device verified.
-Applicator used to insert Nexplanon device [select value="through original/initial incision|through new site that was marked"] on [select value="left arm|right arm"] per manufacturers recommendations.
-Grooved tip of obturator was visible inside needle upon removal.
-Both myself and patient palpated the Nexplanon device in subdermal location.
-The site was dressed with [checkbox value="Dermabond|SteriStrips|pressure dressing|bacitracin ointment"].
-Hemostasis assured.
-Date placed: [date name="NexplanonReinsDate" default="today"]
-Effective for contraception for 3 years, latest recommended date to be replaced to avoid gap in coverage: [calc memo="calc value" value="score1=(NexplanonReinsDate).dateAdd(1095)"].
-If not replaced prior to this date, will need pregnancy test prior to replacement.

[textarea rows="10"]PATIENT DISPOSITION
-EBL < 1ml.
-Wound care instructions reviewed.
-Discussed return precautions to include:
 -bleeding at insertion site that is continuing to soak through pads after first removed
 -worsening pain after first 24 hours
 -increasing swelling after first 24 hours
 -pus coming from insertion site
 -fever[/textarea]

[/conditional]