Emergency Initial and Annual Visit Deferred Exam Supply/follow up visit Pregnancy Testing STD Testing Contraception Visit As indicated from options Topics to consider: Counsel client, as indicated, counseling: Benefits of family based on history and PAM-ACH 8 Prenatal planning; assessment. See to “Topics Care resources for mental in the initial and consider” MCH 25 What is Lead? health and/or substance visit column (see Lead Section abuse; recommendations for domestic violence hotline verbal risk assessment and rape crisis hotline; guidelines) how to use a condom; STD/HIV education; screening pap test; other topics as indicate Provide with FDA POSITIVE TEST - Provide Contraceptive method of Contraceptive method of Contraceptive method Follow-up appointment Approved emergency services based on choice of choice choice- up to 3 month supply of choice for test results and/or contraception options for pregnancy and treatment Multivitamins (Folic Acid Multivitamins (Folic Acid May provide with resources for prenatal, care, supplementation) supplementation) Linkage for partner contraceptive method adoption, foster care, or services Follow-up visit as indicated Follow-up visit for of choice as defined in termination as appropriate. exam and as indicated Condoms Backup barrier method the deferred exam Presumptive eligibility Backup barrier method Contraceptive method, As assessed for individual protocol and follow-up to as indicated patient needs Provide 24 hour Emergency Schedule a family Community Based Number Follow the Provide 24 hour Emergency planning visit, as Services for full Medicaid contraceptive services Number needed benefits (if indicated) protocol Provide backup or A genetic services referral RN may provide OCPs, DMPA, barrier method, as should be recommended rings or patches if unable to needed for previous birth defects, provide the initial/annual exam. including NTD Multivitamins (Folic The initial/ exam may be Refer for prenatal Acid supplementation) appointment to LHD or deferred up to 3 months if the private MD physician/APRN responsible for WIC referral the medical direction of family Referral to HANDS or planning services signs the complete ACH-300 deferred exam protocol (ACH HANDS screen 264B). Prenatal Vitamins NEGATIVE TEST Emergency Contraception, if indicated See Contraceptive Services protocols, as indicated The Matrix identifies the minimal requirements for providing family planning services. Clinicians and nurses must follow the Title X Clinical Requirements outline in the Training Guidelines and Program Descriptions Section of the AR
Initial and Annual Visit Deferred Exam Supply/follow up visit Emergency Contraception Visit Pregnancy Testing STD Testing Topics to consider: Benefits of family planning; resources for mental health and/or substance abuse; domestic violence hotline and rape crisis hotline; how to use a condom; STD/HIV education; screening pap test; other topics as indicate Counsel client, as indicated, based on history and assessment. See “Topics to consider” in the initial and visit column As indicated from options counseling: PAM-ACH 8 Prenatal Care MCH 25 What is Lead? (see Lead Section recommendations for verbal risk assessment guidelines) Contraceptive method of choice Multivitamins (Folic Acid supplementation) Follow-up visit as indicated Backup barrier method As assessed for individual patient needs Provide 24 hour Emergency Number Contraceptive method of choice- up to 3 month supply Multivitamins (Folic Acid supplementation) Follow-up visit for exam and as indicated Backup barrier method Provide 24 hour Emergency Number RN may provide OCPs, DMPA, rings or patches if unable to provide the initial/annual exam. The initial/ exam may be deferred up to 3 months if the physician/APRN responsible for the medical direction of family planning services signs the deferred exam protocol (ACH 264B). Contraceptive method of choice Provide with FDA Approved emergency contraception May provide with contraceptive method of choice as defined in the deferred exam protocol Schedule a family planning visit, as needed Provide backup or barrier method, as needed Multivitamins (Folic Acid supplementation) POSITIVE TEST - Provide services based on choice of options for pregnancy and resources for prenatal, care, adoption, foster care, or termination as appropriate. Presumptive eligibility and follow-up to Community Based Services for full Medicaid benefits (if indicated) A genetic services referral should be recommended for previous birth defects, including NTD Refer for prenatal appointment to LHD or private MD WIC referral Referral to HANDS or complete ACH-300 HANDS screen Prenatal Vitamins NEGATIVE TEST Emergency Contraception, if indicated See Contraceptive Services protocols, as indicated Follow-up appointment for test results and/or treatment Linkage for partner services Condoms Contraceptive method, as indicated Follow the contraceptive services protocol The Matrix identifies the minimal requirements for providing family planning services. Clinicians and nurses must follow the Title X Clinical Requirements outline in the Training Guidelines and Program Descriptions Section of the AR
FamilyPlanningCCSGFY2018.docx