Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
MEDICAL HISTORY
15. Does the patient have a history of any of the following
a. Haemophilia or bleeding disorders: Yes No
b. Diabetes: Yes No
16. Is patient currently being treated or taking medications for any of the
following
a. Anaemia Yes No
b. Diabetes: Yes No
c. AIDS: Yes No
d. Other (specify)___________ Yes No
17. Does patient have any known allergy to medications
Yes No
If yes, specify:___________________________________________
18. Has patient had a surgical operation Yes No
If yes, specify nature, date and any complications:
___________________________________________
19. Does the client have any of the following complaints
a. Urethral discharge: Yes No
b. Genital sore (ulcer): Yes No
c. Pain on erection: Yes No
d. Swelling of the scrotum: Yes No
e. Pain on urination: Yes No
f. Difficulty in retracting foreskin: Yes No
g. Concerns about erection or
sexual function: Yes No
h. Other (specify)________________ Yes No
Facilities and supplies and preparation for surgery Chapter 4-12