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Medical Clinical Protocol Manual

Montana Title X Family Planning

Clinical Protocol Manual

Table of Contents

Clinical Protocol Manual Cover Page
State Seal Page
Revision Page
Table of Contents
Guide to Use of Manual 
Policy Review 
Revisions Sign Off Page
Commonly Used Acronyms

1 - Comprehensive Health History & Periodic Physical Assessment

Revision Date
1-1 Comprehensive Female Health History & Periodic Physical Assessment 8/17
1-2 Comprehensive Male Health History & Periodic Physical Assessment  8/17
1-3 Reproductive Life Plan  8/17

2 - Barrier Methods

Revision Date
2-1 Cervical Cap 8/17
2-2 Diaphragm Fitting 8/17
2-3 Diaphragm Check 8/17
2-4 Female Condom 8/17
2-5 Vaginal Spermicide 8/17

3 - Combined Contraceptives

Revision Date
3-1 Extended Combined Contraception 8/17
3-2 Headache Evaluation 8/17
3-3 Quick Start/Same Day Start Method 8/17
3-4 Amenorrhea Related to CHC Method 8/17
3-5 Manage Breakthrough Bleeding or Unscheduled Bleeding Related to CHC's 8/17

4 - Progestin Only Contraceptives

Revision Date
4-1 Depo Provera (DMPA) 8/17
4-2 Progestin Only Mini Pill POP 8/17
4-3 Emergency Contraceptive Pills 8/17
4-4 Subdermal Implant 8/17

5 - Intrauterine Contraceptive (IUC)

Revision Date
5-1 IUC Candidate/Insertion/Removal of Device 8/17
5-2 IUC Complication- Excessive or Unscheduled Bleeding Pattern Variations 8/17
5-3 IUC Complication- Expulsion 8/17
5-4 IUC Complication- Infection 8/17
5-5 IUC Complication- Missing String(s) 8/17
5-6 IUC Complication- Pelvic Inflammatory Disease 8/17
5-7 IUC Complication- Perforation 8/17
5-8 IUC Complication- Pregnancy 8/17

6 - Other Methods

Revision Date
6-1 Abstinence 8/17
6-2 Fertility Awareness Based, Natural Family Planning and Fertility Awareness Combined Methods 8/17

7 - Positive Pregnancy Test Results and Counseling

Revision Date
7-1 Positive Pregnancy Test Results and Counseling 8/17

8 - Basic Fertility Services

Revision Date
8-0 Basic Fertility Services 8/17

9 - Preconception Health Services

Revision Date
9-0 Preconception Health Services 8/17

10 - Sexually Transmitted & Other Infections

Revision Date
10-1 Anogenital Lesions - HPV 8/17
10-2 Bacterial Vaginosis (BV) 8/17
10-3 Candidiasis 8/17
10-4 Chlamydia 8/17
10-5 Genital Lesions - Herpes Simplex Virus Infection 8/17
10-6 Gonococcal Infection 8/17
10-7 Hepatitis B 8/17
10-8 Hepatitis C 8/17
10-9 HIV Testing 8/17
10-10 Syphilis 8/17
10-11 Trichomoniasis 8/17
10-12 Vaginitis-Atrophic 8/17
10-13 Molluscum Contagiosum 8/17
10-14 Mucopurulent Cervicitis 8/17
10-15 Patient Delivered Partner Therapy (PDPT) 8/17

11 - Related Preventive Services

Revision Date
11-1 Abuse and/or Violence 8/17
11-2 Elevated Blood Pressure- Pre-hypertension Men and Women 8/17
11-3 Nicotine Use and/or Dependence 8/17
11-4 Health Screenings 8/17

12 - Preventive Health Services for Women

Revision Date
12-1 Body Mass Index Variances 8/17
12-2 Breast Concerns 8/17
12-3 Breast Imaging Guidelines 8/17
12-4 Cervical Cytology Management 8/17
12-5 Dysmenorrhea 8/17
12-6 Lactating Mastitis, Breast Engorgement or Breast Abscess 8/17
12-7 Pelvic Inflammatory Disease 8/17
12-8 Premenstrual Syndrome 8/17
12-9 Secondary Amenorrhea 8/17
12-10 Toxic Shock Risks 8/17
12-11 Urinary Tract Infection 8/17
12-12 UTI Pyelonephritis 8/17
12-13 Interstitial Cystitis/Bladder Pain Syndrome 8/17

13 - Preventive Health Services for Men

Revision Date
13-1 Hydrocele 8/17
13-2 Penile Skin Lesions 8/17
13-3 Tinea Corporis (Ringworm) 8/17
13-4 Tinea Cruris (Jock Itch) 8/17

14 - Laboratory Tests

Revision Date
14-1 Abnormal Hemoglobin 8/17
14-2 Hyperglycemia - Prediabetes 8/17
14-3 Glycosuria 8/17