OB/GYN — Contraception Counseling Template
The Contraception Counseling Template is designed for obstetricians, gynecologists, and primary care providers conducting visits focused on contraceptive counseling and initiation. This template documents patient preferences, medical history relevant to contraception, risk assessment for different methods, method selection, patient education, and follow-up planning. The template supports appropriate billing for contraceptive counseling visits and includes sections for patient's reproductive goals and preferences, medical history including contraindications to specific methods, previous contraceptive experience, physical examination if indicated, assessment of appropriate contraceptive options, method selection with shared decision-making, patient education on selected method use, follow-up planning, and STI screening if indicated. This template ensures comprehensive contraceptive counseling, supports patient-centered method selection, facilitates appropriate method initiation, and improves contraceptive adherence through thorough education. Ideal for OB/GYN practices, family medicine practices providing gynecologic care, women's health clinics, and practices managing contraceptive services.
Template
Visit Information
Visit type: Contraception counseling / Method initiation / Method change
Reproductive goals: [Pregnancy desired in X years / Not desired / Unsure]
Medical History
Contraindications: [Hypertension, migraines, DVT, etc.]
Medical conditions: [Relevant conditions]
Current medications: [List]
Allergies: [List]
Previous Contraceptive Experience
Previous methods: [List with duration and reason for discontinuation]
Satisfaction: [What worked, what didn't]
Side effects experienced: [If applicable]
Physical Examination (If Indicated)
Blood pressure: [BP]
BMI: [If relevant for method selection]
Pelvic exam: [If indicated for IUD/implant]
Other: [As indicated]
Contraceptive Options Discussed
1) [Method 1]: [Pros, cons, discussed]
2) [Method 2]: [Pros, cons, discussed]
3) [Method 3]: [As applicable]
Method Selected
Method: [Pill, IUD, implant, injection, patch, ring, etc.]
Rationale: [Why this method selected]
Patient preference: [Patient's choice and understanding]
Patient Education
How to use: [Detailed instructions]
Effectiveness: [Typical and perfect use rates]
Side effects: [Common side effects]
Warning signs: [When to seek care]
STI protection: [Discussed if applicable]
Assessment
1) Contraception counseling completed
- Method selected: [Method name]
- Patient understanding: Good / Needs reinforcement
2) [Other diagnoses as applicable]
Plan
1) Initiate [Method name]: [Instructions]
2) Follow-up: [Return for IUD/implant insertion / Follow-up in X months / As needed]
3) STI screening: [If indicated]
4) Patient education: [Provided as above]
Patient Instructions
Method use instructions provided. Warning signs discussed. Patient verbalized understanding. Follow-up scheduled if needed.
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