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N.C.Department of Environment.Health,and Natural Resources Page_of_ <br /> Division of General Services <br /> FY 1997-98 <br /> CONTRACT ADDENDUM <br /> Women's Preventive Health <br /> Of.ice,Section,or Branch Contract Number <br /> Family Planning <br /> Contractor Activity <br /> SECTION D: QUALITY ASSURANCE DELIVERABLES(continued) <br /> 6. Method specific consent form was reviewed with client,dated,signed by client,and copy given to client. <br /> a. A new consent form is signed with any change in method. <br /> b. Risks specific to the individual due to her/his use of the chosen contraceptive method were identified. <br /> c. Minors under 18 years of age were counseled about the importance of discussing birth control <br /> needs with parent(s)and minor signs forms. <br /> d. Information about emergency and after-hour services was provided. <br /> 7. Screening,Diagnosis,Treatment and Follow-Up Services <br /> There is evidence in the record that: <br /> a. Significant problems were identified and documented. <br /> b. Significant abnormal clinical and laboratory findings were discussed with the client. <br /> c. Problems,conditions,and abnormal findings are appropriately followed. <br /> 8. Service Providers <br /> a. Certain low risk clients may receive designated services from public health nurses that <br /> have received special Family Planning Enhanced Role Training. See Enhanced Role <br /> specifications for detailed criteria. <br /> Reviewed by <br /> DEHNR 3300(Revised 2/97) <br /> General Services Division(Review 1/98) <br /> Initials Date <br />