Templates
Medical
Pre Vasectomy Examination
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Pre Vasectomy Examination

1
Schedule patient for pre-vasectomy examination
2
Prepare patient's medical history
3
Perform a physical examination
4
Discuss desired future fertility plans
5
Perform a testicular examination
6
Take the patient's blood sample
7
Evaluate current medications and allergies
8
Educate the patient on vasectomy procedure
9
Discuss possible vasectomy complications and consequences
10
Explain postoperative care to the patient
11
Answer patient's queries regarding vasectomy
12
Provide patient with written information on vasectomy
13
Obtain informed consent from the patient
14
Approval: Physician to assess examination results
15
Schedule the patient for vasectomy procedure
16
Prepare the examination report
17
Inform patient's primary care provider of the impending procedure
18
Prepare vasectomy procedure kit and instructions
19
Review patient's eligibility for the procedure