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Hormonal Contraceptive Silk-screening QuestionnaireName___ Health Care Providers Name ___ Date___ Date of Birth___ Age*___ Weight___ Do you have health insurance? Yes / No What was the date of your

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How to fill out hormonal contraception selfscreening tool

01

Begin by reading the instructions on the hormonal contraception self-screening tool.

02

Answer all the questions honestly and to the best of your knowledge.

03

Make sure to provide accurate information about your medical history, current medications, and any existing health conditions.

04

Review your answers before submitting the screening tool to ensure completeness and accuracy.

05

If you have any concerns or questions about the screening tool, consult with a healthcare provider.

Who needs hormonal contraception selfscreening tool?

01

Women who are considering starting or switching to hormonal contraception.

02

Women with a history of medical conditions that may affect their ability to safely use hormonal contraception.

03

Women who want to assess their risk factors and suitability for hormonal contraception.

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What is hormonal contraception selfscreening tool?

Hormonal contraception selfscreening tool is a tool that helps individuals assess their eligibility and suitability for hormonal contraception.

Who is required to file hormonal contraception selfscreening tool?

Anyone who is considering using hormonal contraception should fill out the selfscreening tool.

How to fill out hormonal contraception selfscreening tool?

To fill out the selfscreening tool, individuals need to answer a series of questions related to their health history and lifestyle.

What is the purpose of hormonal contraception selfscreening tool?

The purpose of the selfscreening tool is to help individuals make informed decisions about whether hormonal contraception is the right choice for them.

What information must be reported on hormonal contraception selfscreening tool?

Information such as age, medical history, current medications, and lifestyle factors must be reported on the selfscreening tool.

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