Nexplanon is a long-acting contraceptive implant that provides up to three years of contraception. It is a safe and effective form of birth control, but it does require the patient to sign a consent form before it can be implanted. The consent form outlines the risks and benefits associated with the implant and any other relevant information that patients should know before making their decision. By signing this document, patients confirm that they understand all of the data presented in the consent form and are giving informed consent for the procedure. We strongly recommend using a Nexplanon consent form template to create a complete, professional document quickly and easily.
What Is Nexplanon?
Nexplanon is an implantable birth control device inserted under the upper arm’s skin. It slowly releases a hormone called etonogestrel, a type of progesterone, over a period of up to three years. The hormone prevents pregnancy by stopping ovulation and thickening the cervical mucus to prevent sperm from entering the uterus. Nexplanon also makes the lining of the uterus thinner, making it difficult for a fertilized egg to implant.
What Is Nexplanon Consent Form
The Nexplanon consent form is a legal document that outlines the risks and benefits associated with the implant and any other relevant information that patients should know before making their decision. By signing this document, patients confirm that they understand all of the data presented in the consent form and are giving informed consent for the procedure. Additionally, a consent form offers legal protection to the medical practitioner and is an integral part of their recordkeeping process.
The Elements of Nexplanon Consent Form
- (Optional) Business Logo or Name- It is standard practice for businesses to use a professional logo or company/practice name at the top of documents.
- Title- The title of your form should say “Nexplanon Consent Form” in large bold letters at the top to show the reader what this document is for.
- Read Statement- Before the vital information, you may want to include a read statement that warns the patient to read the form and any additional provided materials carefully and discuss their questions or concerns before signing.
- Benefits- List the benefits such as Nexplanon’s efficacy, excellent safety record, and reversibility.
- Common Side Effects- Make a list of the most likely side effects, such as a small scar, discomfort, or pain at the injection site as it is healing, etc.
- Uncommon Side Effects- This is where you mention changes in mood, body weight, acne, and headaches.
- Risks- The risks are rare, but patients need to know that surgical removal or infection can occur. Additionally, this is where you should mention that pregnancy, though exceedingly unlikely, can still happen, and using Nexplanon increases the chance of an ectopic pregnancy.
- Warnings and Other Vital Information- Let the patient know that birth control does not prevent AIDS or STDs when to seek medical care, what services are offered, and how to schedule a voluntary removal.
- Statement of Assent- The assent statement says the patient has read and discussed all the information and that they would like to proceed.
- Consultation Signature and Date Lines- The patient and the clinician must sign and date this form at the time of the initial consultation.
- Placement Signature and Date Lines- Before giving the patient their Nexplanon implant, you must sign again.
How to Use a Nexplanon Consent Form Template
Using a Nexplanon consent form template is efficient and easy. Download the form into your preferred compatible writing program, such as MS Word or Open Office. From there, you can fill out the information and modify the document to include things like your logo. You can also add any additional elements you feel are necessary. Once complete, we recommend reading over your work and doing a basic spelling and grammar check before you print the form. Best of all, you can print multiple copies and use the template over and over again as many times as you need.
Is There an Age Limit for Nexplanon?
There is no specific age limit for Nexplanon, but it is generally recommended for women aged 18 to 40. The safety and efficacy of Nexplanon have been established in clinical trials involving women in this age group. It works by releasing a small amount of progestin hormone into the body, preventing ovulation and thickening cervical mucus, making it difficult for sperm to reach the egg.
People Who Should Not Use Nexplanon
While Nexplanon is generally safe and highly effective, some conditions may prevent your clients from using this product. Here is a list of reasons why someone would not be a good candidate for a Nexplanon implant. Anyone suffering from the conditions on this list should discuss other birth control options with their healthcare provider.
- If they are allergic to any of the ingredients in Nexplanon
- If they are pregnant, think they might be pregnant, or plan to become pregnant in the next 2-5 years
- If they have unexplained vaginal bleeding
- If they have a tumor on their liver
- If they have had liver disease
- If they have had a heart attack or stroke
- If they have serious blood clotting issues such as pulmonary embolisms or deep vein thrombosis, or clots in their eyes causing partial or total blindness
- If they have or had cancers, such as breast cancer, that are sensitive to the hormone progestin
People Who Should Talk to Their Doctor Before Considering Nexplanon
Patients with the conditions on this list should discuss their health with their healthcare provider before getting Nexplanon. Although none of the following is necessarily a bar to using this product, it is essential to ensure this is the right solution when you have comorbidities or take medications that could result in complications or reduced efficacy.
- History of depression
- Allergy to anesthetics or antiseptics (these are used before the procedure to prepare the skin and at the time of removal)
- Headaches or migraines
- High blood pressure
- High triglycerides
- High cholesterol
- Gallbladder issues
- Kidney problems
Is Nexplanon FDA approved?
The US Food and Drug Administration (FDA) has approved the 68 mg etonogestrel implant, known as Nexplanon, for up to three years of use. The implant is designed to provide long-term contraception and can be used by women who want an alternative to other forms of birth control, such as pills or patches. The implant is inserted just beneath the skin in the upper arm, releasing a steady dose of hormones into the body that prevents pregnancy for up to three years. However, it may work for up to five years. It is common for long-term contraceptives to last beyond their FDA-approved limitation, but not guaranteed.
The information provided on this website and the template for a Nexplanon consent form are for informational purposes only and should not be construed as medical advice. We do not provide medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. If you are in need of medical care, please get in touch with a qualified healthcare provider. For additional information about Nexplanon, please refer to the Nexplanon website here (https://www.nexplanon.com/)
Informed consent is an integral part of medical care and creating a Nexplanon consent form with a template can help streamline this process. A Nexplanon Consent Form is a document that outlines the risks and benefits of the procedure and allows a patient to make an informed decision about whether or not to proceed. Nexplanon is a well-respected, long-lasting, safe form of birth control. However, if you are going to implant it in your patients, they must sign a consent form first. These forms are a necessary and vital part of medical documentation. They help protect you from litigation and show that patient rights were respected throughout the consultation and procedure. Creating a consent form using our Nexplanon consent form template is the simplest way to craft a complete, custom, reusable consent form for your patients.