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 65some chances of failure of the operation <strong>for</strong> which the operating doctor <strong>and</strong> thehealth facility will not be held responsible by me or by my relatives or by any otherperson whomsoever.c)d)e)f)g)h)i)j)I am aware that I am undergoing an operation that carries an element of risk.The eligibility criteria <strong>for</strong> the operation have been explained to me, <strong>and</strong> I affirm thatI am eligible to undergo the operation according to the criteria.I agree to undergo the operation under any type of anaesthesia that the doctor/health facility thinks suitable <strong>for</strong> me <strong>and</strong> to be given other medicines as consideredappropriate by the doctor/health facility concerned.If, after the sterilization operation, I/my spouse experience (s) a missed menstrual cycle,then I/my spouse shall report within two weeks of the missed menstrual cycle to thedoctor/health facility <strong>and</strong> may avail of the facility to get an MTP done free of cost.In case of complications following the sterilization operation, including failure, I willaccept the compensation as per the existing provisions of the Government of IndiaFamily Planning Insurance Scheme as full <strong>and</strong> final settlement.If I/my wife get (s) pregnant after the failure of the sterilization operation <strong>and</strong> if Iam not able to get the foetus aborted within two weeks, then I will not be entitledto claim any compensation over <strong>and</strong> above the compensation offered under theFamily Planning Insurance Scheme from any court of law in this regard or any othercompensation <strong>for</strong> the upbringing of the child.I agree to come <strong>for</strong> follow-up visits to the hospital/institution/doctor/health facilityas instructed, failing which I shall be responsible <strong>for</strong> the consequences, if any.I underst<strong>and</strong> that vasectomy does not result in immediate sterilization. *I agree tocome <strong>for</strong> semen analysis three months after the operation to confirm the success ofthe sterilization surgery (azoospermia), failing which I shall be responsible <strong>for</strong> theconsequences, if any.(*Applicable in cases of male sterilization)I have read the above in<strong>for</strong>mation.# The above in<strong>for</strong>mation has been read out <strong>and</strong> explained to me in my own language,<strong>and</strong> it has been explained to me that this <strong>for</strong>m has the authority of a legal document.