Family Planning Service Providers
Protocol
Documents
- Table of Contents
- Title X Family Planning Program Priorities
- Protocol Change Sheet
- Summary of Protocol Revisions
- PHD Staff Roles in the Provision of FP Services
- Signed Signature Page
Sections
- Section 1 - Guidelines for Clinical Services
- Section 2 - Contraceptive Methods
- Section 3 - Pharmacy PA Formulary
- Section 3 - Pharmacy PHO Formulary
- Section 4 - Laboratory
- Section 5 - Special Populations
Appendices
- Appendix A - PHD Emergency Medical Response Protocol
- Appendix B - Fee Collection Protocol
- Appendix C - Education Resources
- Appendix D - Staff Orientation
- Appendix E - Language ID Flashcard
- Appendix F - Referrals
- Appendix G - Part 1 – Summary of US Contraceptive Use Medical Eligibility Criteria
- Appendix G - Part 2 – MMWR US Medical Eligibility Criteria for Contraceptive Use
- Appendix G – Part 3 – US MEC Update: Recommendations Among Women at Risk for HIV
- Appendix H- Part 1- U.S. Selected Practice Recommendations, 2016
- Appendix H- Part 2- U.S. Selected Practice Recommendations, 2021 Update Self-Administration
- Appendix I - Part 1 - MMWR Providing Quality Family Planning Services 2014 (QFP)
- Appendix I - Part 2 - QFP Update 2015
- Appendix I – Part 3 – QFP Update 2017
- Appendix J- Client Consents, Handouts and Tools
Forms
New Mexico Department of Health Family Planning Program forms can be found in the list below. All client handouts and information sheets are in English and Spanish
NOTE: These forms are effective 09/2021.
Long-Acting Reversible Contraceptive Methods (LARCs):
- Contraceptive Implant – Consent Form
- Contraceptive Implant – Counseling Handout
- Contraceptive Implant – Post Insertion and Removal Instructions
- Paragard IUD – Consent Form
- Paragard IUD – Counseling Handout
- Levonorgestrel IUD – Consent Form
- Levonorgestrel IUD – Counseling Handout
Sterilization:
- Sterilization – Request Form
- Sterilization – Consent Form (English)
- Sterilization – Consent Form (Spanish)
- Sterilization – Counseling Handout
- Sterilization – Evaluation
Depo Provera (DMPA):
- DMPA – Counseling Handout
- DMPA – Perpetual Calendar
- DMPA – Sub-Q Disposal of Needles and Unused Medication Handout
- DMPA – Sub-Q Self-Injection Handout
Birth Control Pills and Combined Hormonal Methods:
- Birth Control Pills COCs – Counseling Handout
- Birth Control Pills COCs – Missed Pill Instructions
- Birth Control Pills – How to Start Taking Birth Control Pills
- Birth Control Pills POPs – Counseling Handout
- Birth Control Pills POPs – Missed Pill Instructions
- Vaginal Contraceptive Ring – Counseling Handout
Other Contraceptive Methods:
- ECP – Counseling Handout
- Condoms (External) – Counseling Handout
- Condoms (Internal) – Counseling Handout
- Fertility Awareness-Based Methods (FABM) – Smartphone Apps
- Lactational Amenorrhea Method (LAM) – Counseling Handout
- Contraceptive Spermicide (Film, Foam, and Gel) – Counseling Handout
- Contraceptive Spermicide (Film, Foam, and Gel) – Instructions
- Abstinence – Counseling Handout
Contraceptive Emergency Instructions:
- Emergency Care Instructions – OCP/Patch/Vaginal Ring
- Emergency Care Instructions – DMPA and Contraceptive Implant
- Emergency Care Instructions – IUD
Preconception and Pregnancy Handouts:
Other Clinic Forms:
- Educational Resources Order Form
- Educational Materials Sample 2022
- Documentation of Observed Family Planning Procedures
- Pregnancy Occurrences Report
- Acknowledgement of Abnormal Medical Condition
Fee Collection Forms:
Resource List For Pregnant Clients
Northeast
Southeast
2019 New Mexico Title X Family Planning Update & Reproductive Health teleECHO
This Reproductive Health: 2019 Protocol Update Video is presented by: New Mexico Department of Health Family Planning Program & UNM Reproductive Health ECHO.
Please see the 2019 Family Planning Protocol Update.
Please see the 2020 Family Planning Protocol Addendum for Syphilis Testing with Positive Pregnancy Test.
Please see the 2020 STD Protocol Revision – Syphilis Screening in Pregnancy.
Please see the 2020 PHD Guidelines for Providing Clinical Services in Public Health Offices During the COVID-19 (Coronavirus) Pandemic, dated 04/03/2020.
Please see the Strategies for Providing Family Planning Services during COVID-19 Pandemic and Family Planning Telemedicine, presented on 4/15/20 in partnership with UNM Reproductive Health ECHO.
Staff Training (effective September 27, 2021)
There are four Title X specific trainings that are required by the Family Planning Program in New Mexico for public health office staff and provider agreement staff depending on their function/license.
The term "all staff" refers to every person who works with or has contact with Title X clients, including receptionists, clerks, administrative staff, clinical staff (medical assistants & medical/medication technicians), licensed professionals (clinicians and nurses), volunteers and students.
NOTE: Keep certificates of completion with your supervisor's signature on file at your worksite.
Required Training
Title X
All staff are required to complete Title X training within 30 days of hire or delivering of Title X services and annually thereafter. There are two different trainings, one for non-clinical staff and one for clinical staff. Please make sure you click on the appropriate link depending on your job function.
Non-Clinical
- Gain knowledge to determine a client's need for a range of services.
- Inform and educate staff regarding information provided in the "New Mexico Family Planning Fee Collection Protocol", "Program Requirements for Title X Funded Family Planning Projects" and "Providing Quality Family Planning Services: Recommendations of CDC and the US Office of Population Affairs."
- Provide guidance on how to complete an income assessment & consent form.
Clinical
- Gain knowledge to determine a client's need for a range of services.
- Inform and educate staff regarding information provided in the "New Mexico Family Planning Fee Collection Protocol," "Program Requirements for Title X Funded Family Planning Projects" and "Providing Quality Family Planning Services: Recommendations of CDC and the US Office of Population Affairs."
- Provide guidance on how to complete an income assessment & consent form.
- Assist clients in developing a client centered reproductive life plan.
- Provide counseling on contraception, pregnancy testing, achieving pregnancy and basic infertility, sexually transmitted infections, preconception health, related preventive health and referrals.
Reporting Abuse and Human Trafficking
All staff are required to complete this training within 30 days of hire or delivering of Title X services and annually thereafter.
This training provides basic guidelines to for most common situations seen in New Mexico Title X clinics. All clinic providers will also follow your agencies guideline/protocol for reporting, tracking, and documenting reports made for adult/child abuse and human trafficking.
Visit the Child Abuse/Neglect Reporting & Human Trafficking Online Training page to begin.
These courses (above) are located on NMTRAIN (Home - NM.TRAIN - an affiliate of the TRAIN Learning Network powered by the Public Health Foundation) and requires the user to create an account to print certificates following completion of the course and assessment.
For help setting up an account, go to TRAIN Tutorials
Cultural Competency in Family Planning Care eLearning
All staff are required to complete this training at least once within 90 days of hire or delivering Title X services.
This training course (Cultural Competency in Family Planning Care eLearning) is located on the Reproductive Health National Training Center (RHNTC) website at Reproductive Health National Training Center (rhntc.org) (formerly known as FPNTC). This course can help service sites fulfill the Title X program requirement for training on culturally competent care to better meet the needs of diverse populations in the Title X network.
The user is FIRST required to create a RHNTC account at Reproductive Health National Training Center (rhntc.org), log in, enter course name in "Search" field then proceed to complete the course. Print a certificate after completion.
Course link: Cultural Competency in Family Planning Care - Overview (rhntc.org), however create account FIRST and log in before completing this course.
Violence, Alcohol Abuse, Substance Abuse, Tobacco Use
Only licensed professionals are required to complete this Violence, Alcohol Abuse, Substance Abuse, Tobacco Use (VAST) training at least once within 30 days of hire or delivering of Title X services.
- Family Planning VAST Training Course
- Family Planning VAST Guidebook
- Family Planning VAST Training Certificate
- Print the certificate above and fill it out.
Other Required Trainings
For other requirements, refer to your agency’s written policies & procedures for trainings that address HIPAA, civil rights and work safety.
Reproductive Health Clinic
For more information, and to sign up for email notifications of webinars, or access to the curriculum schedule and case presentation form links, go to the Reproductive Health | ECHO Institute Programs website.