Office practice tools
These tools below are designed to aid primary care clinicians to integrate reproductive health services into their own practice. These tools are also embedded in the Practice Integration chapter of the workbook.
TEACH provides open access to the forms below. Any forms used in a public forum should acknowledge the TEACH program. If you would like .doc files to alter forms to your clinic’s needs, please contact us at: info(at)teachtraining.org
Patients
Information
- Abortion Medication Fact Sheet (NAF)
- Chart Review Form Medication Abortion
- Comparison of Medication and Aspiration Abortion (RHAP)
- Contraceptive Options Fact Sheet (RHAP)
- Early Medication Abortion using Methotrexate and Misoprostol
- Ectopic Pregnancy Fact Sheet (RHAP)
- Emergency Contraception Fact Sheet
- Transfer Agreement
- Working With An Interpreter Training Tool
- Current State Laws and Policies (Guttmacher)
Consents
Clinical Support
Med AB
- Medication Abortion Protocol Using Mifepristone & Misoprostol (RHAP)
- Medication Abortion Protocol Using Misoprostol Alone (RHAP)
- Medication Abortion Protocol Using Methotrexate and Misoprostol
- Medical Management of Miscarriage Policy (RHAP)
- Medication Abortion Chart Review
- Medication Abortion Log
- Medication Abortion Follow-up Log
- Medication Abortion Visit
- Mifepristone Patient Agreement Form (Danco)
- How to Order Mifepristone (RHAP)
- MAB Aftercare Instructions (RHAP)
- Algorithm for Triaging Bleeding After Medication Abortion (RHAP)
MVA
- MVA Chart Review
- MVA Procedure Notes
- MVA Pre-Procedure Notes
- Abortion Aftercare Instructions (RHAP)
- MVA for Therapeutic Abortion Policy & Procedure (RHAP)
- Nursing Policy & Procedure for MVA (RHAP)
- MVA for Miscarriage Policy & Procedure (RHAP)
Values Clarification
Clinics
Administration
- Security Drills
- Disruption / Violence Report for Staff
- Medical Emergency Drills (TEACH)
- Abortion clinic violence statistics and history (NAF)
- Emergency Contact Numbers
- Bomb Threat Report Form
- Transfer Agreement
- Incident Report
- FP Insurance Letter
- Insurance Proposal
- Interpreter Agreement
Clinical
- Patient Intake Form
- Patient satisfaction survey 2016
- Phone Script
- IV-Sedation
- Sample Complication Log
- Training Checklist for Staff in Procedure Room
Equipment
- Decontaminating, Cleaning & Disinfecting the IPAS Syringe (Ipas)
- Unwrapping Sterile Packs (Poster)
- Wrapping Instruments (Poster)
- Reprocessing Vaginal Ultrasound Probe (Poster)
- General tissue disposal
Training/Competency
Please note: tools are often updated and the information contained in this website or transmitted to you electronically in response to a message is not intended nor implied to constitute medical advice, diagnosis, or treatment. Always visit or speak to a qualified health care professional in person prior to starting any new treatment or with any question you have regarding a medical condition. This website does not directly or indirectly practice medicine or dispense medical advice as part of this service. Neither TEACH nor its agents are responsible for adverse clinical outcomes that might occur where they are not expressly and directly involved in the role of primary caregiver.