|
|
|
|
Nexplanon Insertion Procedure Note
|
Performing Clinician
|
|
|
Site (check)
|
|
|
Serial #
|
|
|
Sterile Preparation
• • •
|
|
|
Expiration Date
|
|
1% Lidocaine Dose (ml's) # only
|
1% Lidocaine
|
|
|
Estimated Blood Loss (ml) Only type #
|
|
|
Dressings Applied
• • •
|
|
Followup: No Complications
|
Followup: Complications
|
|
Standard Post-Procedure Care WNL
|
Standard Post-Procedure Care Other
|
|
Nexplanon Removal Procedure Note
|
|
|
Nexplanon Removal Procedure Note
|
|
