Documentation at the service site(s) (e.g., staff circulars, training curriculum) indicates staff has been informed at Site A: ___ least once during the current project period that a client’s A Site B: ___ receipt of family planning services may not be used as a Site C: ___ prerequisite to receipt of any other services offered by the service site. Administrative policies at service include a written Site A: ___ statement that receipt of family planning services is not a A Site B: ___ prerequisite to receipt of any other services offered by Site C: ___ the service site. General consent or other documentation provided to Site A: ___ clients states that receipt of family planning services is A Site B: ___ not a prerequisite to receipt of any other services offered Site C: ___ by the service site. Medical record review demonstrates that each client has Site A: ___ signed a general consent form stating receipt of family C Site B: ___ planning services is not a prerequisite to receipt of any Site C: ___ other services offered. Section 8.1.3: Personnel Awareness Personnel working within the family planning project must be informed that they may be subject to prosecution if they coerce or try to coerce any person to undergo an abortion or sterilization procedure (Section 205, Public Law 94-63, as set out in 42 CFR 59.5(a)(2) footnote 1). Sub-Recipient/ Not Reviewer Implementation Strategy Comments Met Service Site Met Code Grantee has written policies and procedures that require that all staff of the grantee, sub-recipients, and service A sites is informed that they may be subject to prosecution if they coerce or try to coerce any person to undergo an abortion or sterilization procedure. Documentation at the grantee level demonstrates that A staff has been informed at least once during the current project period that they are subject to this requirement. Documentation at sub-recipients and service (e.g., Site A: ___ staff circulars, training records) demonstrates that staff A Site B: ___ has been informed at least once during the current Site C: ___ project period that they are subject to this requirement. 8.1 Additional Comments: [e.g., 10 out of 10 requirements”] “Met
A Site A: ___ Site B: ___ Site C: ___ Documentation at the service site(s) (e.g., staff circulars, training curriculum) indicates staff has been informed at least once during the current project period that a client’s receipt of family planning services may not be used as a prerequisite to receipt of any other services offered by the service site. A Site A: ___ Site B: ___ Site C: ___ Administrative policies at service include a written statement that receipt of family planning services is not a prerequisite to receipt of any other services offered by the service site. A Site A: ___ Site B: ___ Site C: ___ General consent or other documentation provided to clients states that receipt of family planning services is not a prerequisite to receipt of any other services offered by the service site. C Site A: ___ Site B: ___ Site C: ___ Medical record review demonstrates that each client has signed a general consent form stating receipt of family planning services is not a prerequisite to receipt of any other services offered. Section 8.1.3: Personnel Awareness Personnel working within the family planning project must be informed that they may be subject to prosecution if they coerce or try to coerce any person to undergo an abortion or sterilization procedure (Section 205, Public Law 94-63, as set out in 42 CFR 59.5(a)(2) footnote 1). Reviewer Code Met Not Met Sub-Recipient/ Service Site Implementation Strategy Comments A Grantee has written policies and procedures that require that all staff of the grantee, sub-recipients, and service sites is informed that they may be subject to prosecution if they coerce or try to coerce any person to undergo an abortion or sterilization procedure. A Documentation at the grantee level demonstrates that staff has been informed at least once during the current project period that they are subject to this requirement. A Site A: ___ Site B: ___ Site C: ___ Documentation at sub-recipients and service (e.g., staff circulars, training records) demonstrates that staff has been informed at least once during the current project period that they are subject to this requirement. 8.1 Additional Comments: [e.g., “Met 10 out of 10 requirements”]
opa_program_rev_tool_2017.docx