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LORETTA (levonorgestrelreleasing intrauterine system) TM PRESCRIPTION & ENROLLMENT FORM Four simple steps to submit your referral. 1 PATIENT INFORMATION 3 CLINICAL INFORMATION New patient Current
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How to Fill Out Liletta(tm) Levonorgestrel-Releasing Intrauterine System:

01
Before starting the process, make sure you have received proper training and guidance from a healthcare professional on how to insert the Liletta(tm) intrauterine system.
02
Begin by gathering all the necessary equipment and supplies, including sterile gloves, antiseptic solution, speculum, vaginal tenaculum, uterine sound, and the Liletta(tm) IUS itself.
03
Wash your hands thoroughly and put on the sterile gloves to ensure cleanliness during the procedure.
04
Position the patient in the lithotomy position, ensuring their comfort and proper exposure of the cervix.
05
Conduct a thorough examination of the patient's cervix and uterine size to determine the appropriate placement of Liletta(tm). This involves using a speculum to visualize the cervix, grasping the cervix with the tenaculum for stabilization, and measuring the uterine depth with the uterine sound.
06
Once the appropriate depth is measured, securely hold the Liletta(tm) IUS by the inserter, ensuring that the retrieval threads are visible and intact.
07
Carefully insert the Liletta(tm) IUS into the uterus through the cervix. You may experience slight resistance during this step, but it should not cause significant pain or discomfort for the patient.
08
After the Liletta(tm) IUS is properly positioned in the uterus, release the IUS by pushing the slider on the inserter until the arms of the IUS open fully and 1.5 cm of the thread is left outside the cervix.
09
Withdraw the inserter, leaving the Liletta(tm) IUS in place.
10
Perform a final check to ensure the correct placement of the IUS using appropriate techniques (e.g., gentle traction on the threads, ultrasound guidance).
11
Provide the patient with thorough post-insertion instructions, including information on common side effects, signs of complications, and when to follow up with their healthcare provider.

Who Needs Liletta(tm) Levonorgestrel-Releasing Intrauterine System:

01
Liletta(tm) is suitable for women who are looking for long-term birth control options that are highly effective and reversible.
02
It is specifically designed for women who desire contraception for up to three years.
03
Liletta(tm) may be recommended for women who have had at least one child and are seeking reliable, low-maintenance contraception.
04
This intrauterine system (IUS) may also be an appropriate choice for women who prefer a hormone-based contraceptive method that provides localized delivery of levonorgestrel, a progestin hormone.
05
With proper consultation from a healthcare professional, Liletta(tm) can be considered by women who do not have contraindications or significant risk factors that prevent them from using an IUS.
Please note that specific eligibility for Liletta(tm) may vary depending on individual medical history and factors. It is important to consult with a healthcare provider to determine if Liletta(tm) is the right contraceptive option for you.
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Liletta™ levonorgestrel-releasing intrauterine system is a hormonal intrauterine device (IUD) that is inserted into the uterus to prevent pregnancy.
A healthcare provider is required to insert and file the lilettatm levonorgestrel-releasing intrauterine system for the patient.
The healthcare provider will insert the lilettatm levonorgestrel-releasing intrauterine system into the uterus following the manufacturer's instructions.
The purpose of lilettatm levonorgestrel-releasing intrauterine system is to provide long-lasting, reversible contraception for women.
The healthcare provider must report the insertion date, patient information, any side effects, and follow-up appointments related to the lilettatm levonorgestrel-releasing intrauterine system.
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