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

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68<strong>St<strong>and</strong>ards</strong> <strong>for</strong> female <strong>and</strong> male <strong>Sterilization</strong> servicesAnnexure 5Post-operative Instruction Card following<strong>Female</strong> <strong>Sterilization</strong>Name <strong>and</strong> type of hospital/facility ........................................................................................................................Acceptor’s name ........................................................................................................................Father’s name ........................................................................................................................Husb<strong>and</strong>’s name ........................................................................................................................Address........................................................................................................................................................................................................................................................................................................................................................................Contact number (if available)........................................................................................................................Date of operationType of operation.............................../................................./................................ (D/M/Y)Minilap/Post-partum/Laparoscopic (SP/DP).......................................

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