Standards for Female and Male Sterilization Services - STATE ...
Standards for Female and Male Sterilization Services - STATE ...
Standards for Female and Male Sterilization Services - STATE ...
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<strong>St<strong>and</strong>ards</strong> <strong>for</strong> female <strong>and</strong> male <strong>Sterilization</strong> services 57HypertensionMental illnessSexual problemsProstatitisEpididymitisH/O blood transfusionGynaecological problemsCurrently on medication (if yes, specify)Yes.............................................. No...................................................Yes.............................................. No...................................................Yes.............................................. No...................................................Yes.............................................. No...................................................Yes.............................................. No...................................................Yes.............................................. No...................................................Yes.............................................. No...................................................Yes.............................................. No...................................................Comments........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Physical ExaminationBP........................................... Pulse...........................................Temperature........................................LungsHeartAbdomenNormal..................................... Abnormal..........................................Normal..................................... Abnormal..........................................Normal..................................... Abnormal..........................................3. Local examination<strong>Male</strong> sterilizationSkin of scrotumTestisEpididymisHydroceleVaricoceleHerniaVas deferensBoth vas palpableNormal..................................................... Abnormal.....................................................Normal..................................................... Abnormal.....................................................Normal..................................................... Abnormal.....................................................Yes............................................................. No.................................................................Yes............................................................. No.................................................................Yes............................................................. No.................................................................Normal..................................................... Abnormal.....................................................Yes............................................................. No.................................................................