APPENDIX 9 - PATIENT'S FORMS

 

For a proper administration the use of standard forms is recommended. Forms to be filled in by the patient or given to her after the procedure should be available in different languages. By using a computerised administration the forms can be generated for every individual patient. This abolishes the need to print heaps of forms and if some minor change must be made it is not necessary to destroy the old forms.

 

The following forms may be used:

 

1. Patients fill in form:

Her own identification details

Name and address of her doctor

May she be contacted by letter or telephone

Consent to inform her doctor

 

2. Anamnesis

3. Results of examination.

4. Counselling.

5. Account of the termination procedure.

6. Medicines given.

7. Instructions for the patient after the procedure.

8. Instructions for the patient before the procedure.

 

The first form includes consent to contact the patient at home. In practice this is seldom necessary. But if you phone a patient, for instance if she forgot her watch, and you get a husband who does not know that his wife had an abortion, you cause and get much trouble. It also asks for consent to inform her doctor.

Form number 8, instructions for the patient before she comes to the clinic, contains such details as the exact place where the clinic can be found, instructions to be starved in case of general anaesthesia and so on.

Informing the doctor by letter is recommended. The letter gives some details about the procedure and suggestions of the follow up examination. If the attitude of the doctor is not known the letter may contain the clinic number rather than the identification of the patient. The patient should be instructed to visit her doctor and mention the number. If you give the letter in the hands of the patient, in my experience only a fraction of the letters reach the doctor. Sending a letter by mail gives your clinic a good image and your doctor knows where to send his next patient. The letter may contain form number 8 for this purpose.

 

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