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Forms

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Sterilization – Counseling Handout Family Planning - Form September 25, 2021

Sterilization – Counseling Handout

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Sterilization – Evaluation Family Planning - Form September 25, 2021

Sterilization – Evaluation

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DMPA – Counseling Handout Family Planning - Form September 25, 2021

DMPA – Counseling Handout

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DMPA – Perpetual Calendar Family Planning - Form September 25, 2021

DMPA – Perpetual Calendar

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DMPA – Sub-Q Disposal of Needles and Unused Medication Handout Family Planning - Form September 25, 2021

DMPA – Sub-Q Disposal of Needles and Unused Medication Handout

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DMPA – Sub-Q Self-Injection Handout Family Planning - Form September 25, 2021

DMPA – Sub-Q Self-Injection Handout

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Preconception Health and Instructions for an Optimal Pregnancy Family Planning - Form September 25, 2021

Preconception Health and Instructions for an Optimal Pregnancy

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Pregnancy Choices Family Planning - Form September 25, 2021

Pregnancy Choices

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Educational Resources Order Form Family Planning - Form September 25, 2021

Educational Resources Order Form

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Educational Materials Sample 2022 Family Planning - Form September 25, 2021

Educational Materials Sample 2022

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Documentation of Observed Family Planning Procedures Family Planning - Form September 25, 2021

Documentation of Observed Family Planning Procedures

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Pregnancy Occurrences Report Family Planning - Form September 25, 2021

Pregnancy Occurrences Report

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Acknowledgement of Abnormal Medical Condition Family Planning - Form September 25, 2021

Acknowledgement of Abnormal Medical Condition

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Consent for Family Planning Services Family Planning - Form September 25, 2021

Consent for Family Planning Services

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Hardship Declaration Form Family Planning - Form September 25, 2021

Hardship Declaration Form

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Sliding Fee Scale Family Planning - Form September 25, 2021

Sliding Fee Scale

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Payment Ledger Family Planning - Form September 25, 2021

Payment Ledger

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Fee Deposit Register Family Planning - Form September 25, 2021

Fee Deposit Register

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Fee Deposit Slips Family Planning - Form September 25, 2021

Fee Deposit Slips

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Fax Cover Sheet Family Planning - Form September 25, 2021

Fax Cover Sheet