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Medical Clinical Protocol Manual

Medical Clinical Protocol Manual

Table of Contents

SECTION

TITLE/CONTENT

Last Updated

     Reference Information
  001 Current Acronym List 03/09
  002 Front Cover 09/13
  003 Med Guide to Use Manual 09/13
  004 Policy Review 09/13
  005 References 01/09
  006 Revision Cover Sheet 04/14
  007 Revisions Signoff 09/13
  008 State Seal Inside Cover 09/13
  009 Table of Contents 04/14
       
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1    Diaphragm
  1-1 Diaphragm Fitting 03/14
  1-2 Diaphragm Check 03/14
  1-3 Diaphragm Annual Exam 03/14
       
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2   IUC
  2-1 ID of IUC candidate 03/14
  2-2 IUC Insertion Visit 07/12
  2-3 IUC Removal 04/14
  2-4 IUC Vasovagal Reaction 03/14
  2-5 IUC Insertion Complication - Uterine Perforation 07/07
  2-6 IUC Missing String Not Pregnant 07/07
  2-7 IUC Pregnant 03/14
  2-8 Contraceptive Exam IUC Check Potential Complications 07/04
  2-9 IUC Complications Bleeding Variations 04/08
  2-10 IUC Complications PID 03/14
  2-11 IUC Complications-Genital Actinomycosis 04/14
       
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3 Combined Hormonal Contraceptives (CHC)
  3-1 CHCs Initial Start 04/14
  3-2 Follow-up of Initial Start 07/12
  3-3 CHC Oral Pregnancy with Use 04/08
  3-4 CHC Continuous Cycling 11/10
  3-5 Ortho Evra Initial Start 10/11
  3-6 Vaginal Ring 10/11
  3-7 CHC Oral Annual Exam 11/10
  3-9 Contraceptives Breakthrough Bleeding (BTB) Low Estrogen Content (20-35 mcg) 04/08
  3-10 Headache Evaluation 04/14
  3-11 Emergency CHC Estrogen-Progestin 04/08
  3-12 Emergency Contraceptive COC and Progestin Only by Phone 09/08
       
 
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4   Progestin Only Contraceptives
  4-1 Depo Initial 11/10
  4-2 Depo Revisits 11/10
  4-3 Progestin Only Initial Start 11/10
  4-4 Emergency Contraception 4/10
  4-5 Implant 10/11
   
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5    Other Methods
  5-1 Non-Hormonal Methods Natural FP 04/14
  5-2 Non-Hormonal Methods Condoms 07/94
  5-3 Non-Hormonal Methods Vaginal Spermicides AKA Contraceptive Film 12/02
  5-4 Non-Hormonal Methods Cervical Cap Fitting 04/14
  5-5 Non-Hormonal Methods Cervical Cap 3 Month Check 05/93
  5-6 Non-Hormonal Methods Cervical Cap Annual Exam 05/93
  5-7 Non-Hormonal Methods Abstinence 07/05
   
6   Failure Rates
  6-1 Summary Table of Contraceptive Efficacy 04/13
   
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7   Pelvic Inflammatory Disease (PID)
  7-1 PID 04/14
   
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8   Urinary Tract Infection
  8-1 Cystitis 04/08
  8-2 Pyelonephritis 04/08
  8-3 UTI Chronic Bacteriuria 11/90
  8-4 UTI Interstitial Cystitis 10/07
   
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9   Amenorrhea
  9-1 Primary Dysmenorrhea 10/05
  9-2 Delayed Menses or Secondary Amenorrhea in Premenopausal Women 10/05
  9-2 (1) Delayed Menses or Secondary Amenorrhea 04/09
  9-3 Pregnancy 04/14
   
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10   Breast Normal/Abnormal
  10-1 Breast Exam Mammography Screening Guidelines 05/13
  10-2 Breast Fibrocystic 10/11
  10-3 Nipple Discharge galactorrhea 10/11
  10-4 Nipple Discharge non-galactorrhea 07/05
  10-5 Breast Mass 10/11
  10-6 Mastitis 07/05
       
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11   Blood Pressure Elevated  
  11-1 BP Elevated without CHC (oral) 04/14
  11-2 BP Elevated with CHC 04/14
       
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12   Overweight/Underweight  
  12-1 Overweight Underweight BMI Variances 11/04
       
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13   PAP Smears  
  13-1 Pap Smear Infection Inflammation 11/07
  13-2 Pap Smear Epithelial and Glandular Changes 11/07
  13-3 Pap Smear Initiation and Interval Screening ACOG 07/12
       
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14   Laboratory Tests
  14-1 Glycosuria 10/09
  14-2 Hyperglycemia 10/09
  14-3 Hemoglobin Hematocrit Abnormal Hct 32 Percent Hgb 10g-dl or Lower 07/04
  14-4 HGB 10-12 HCT 33-36 07/04
  14-5 HCT 51 Percent 07/04
       
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15   Sexually Transmitted Infections/Vaginitis  
  15-1 STI Bacterial Vaginosis 04/09
  15-2 STI Monilia 04/09
  15-3 STI Condylomata Acuminata 04/09
  15-4 STI Gonorrhea 09/11
  15-5 STI Herpes Simplex II 04/09
  15-6 STI Molluscum Contagiosum 04/09
  15-7 STI Pediculosis Pubis 07/03
  15-8 STI Syphilis 07/03
  15-9 STI Trichomoniasis 09/11
  15-10 STI Chlamydia 04/09
  15-11 STI Screening Criteria 04/09
  15-12 Preliminary Reactive HIV Results Rapid HIV Antibody Test 04/10
  15-13 Positive Confirmatory HIV Results 04/10
  15-14 Patient Delivered Partner Treatment 07/12
       
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16   Male Reproductive Health Services  
  16-1 Initial Male Exam 13-17 10/08
  16-2 Initial Male Exam 18+ 09/08
  16-3 Balanitis 10/08
  16-4 Epididymitis 10/08
  16-5 Hydrocele 09/08
  16-6 Inguinal Hernia 10/08
  16-7 Orchitis 10/08
  16-8 Penile Skin Lesions 10/08
  16-9 Prostatitis 10/08
  16-10 Testicular Torsion 10/08
  16-11 Testicular Tumor 10/08
  16-12 Tinea Corporis 10/08
  16-13 Tinea Cruris 10/08
  16-14 Urethritis 10/08
  16-15 UTI 10/08
  16-16 Varicocele 10/08
       
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