Standards for Female and Male Sterilization Services - STATE ...

More documents

Recommendations

Info

66Standards for female and male Sterilization servicesName and signature/thumb impression of the acceptor..................................................................................................Signature of witness:.........................................................................................Full name.......................................................................Full address....................................................................# (Only for those beneficiaries who cannot read and write)Applicable in cases where the client cannot read and where the aboveinformation has been read out.Shri/Smt ......................................................................................... has been fully informed aboutthe contents of the Informed Consent Form in his/her own/local language.I certify that I have satisfied myself that:Signature of counsellor**Full name ......................................................................Full address ...................................................................1) Shri/Smt ................................................................. is within the eligible age group and ismedically fit for the sterilization operation.2) I have explained all clauses to the client and also explained that this form has theauthority of a legal document.3) I have filled out the medical record-cum-checklist and followed the standards forsterilization procedures as laid down by the Government of India...................................................... ............................................................................................Signature of operating doctorSignature of medical officer in-charge of the facility(Name and address) Seal(Name and address) Seal
Standards for female and male Sterilization services 67Denial of sterilizationI certify that Shri/Smt .......................................................................... is not a suitable client forre-sterilization/sterilization for the following reasons:1.2.He/she has been advised the following alternative methods of contraception:1.2.Signature of the counsellor** ordoctor making the decision(Name and full address)(** The counsellor can be any health personnel, including a doctor).
Page 6:
DR. (SMT.) M.S. JayalakshmiDeputy C
Page 14:
Standards for female and male Steri
Page 18 and 19:
Standards for female and male Steri
Page 20 and 21:
10Standards for female and male Ste
Page 22 and 23:
Page 24 and 25:
Page 27 and 28: Standards for female and male Steri
Page 45: Standards for female and male Steri
Page 54 and 55: 44Standards for female and male Ste
Page 56 and 57: 46Standards for female and male Ste
Page 58: 48Standards for female and male Ste
Page 75: Standards for female and male Steri
show all

Standards for Female and Male Sterilization Services - STATE ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?