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Implanon®: Doctor checklist and patient consent form

The doctor checklist and patient consent form for the insertion of IMPLANON® NXT has been developed by the RACGP's National Standing Committee - Quality Care and National Standing Committee- GP Advocacy & Support to assist General Practitioners maintain a high level of quality and safety in the insertion of IMPLANON® NXT .

The forms are designed for use in a three-stage process - an initial consultation followed by the insertion and removal of the implant. Medical Indemnity Insurers (MIIs) may have requirements regarding IMPLANON® NXT

Merck Sharp and Dohme (MSD) may have requirements for training in the insertion of this product. It is important to be aware of this and the need to complete appropriate training that meets the educational requirements prior to inserting IMPLANON® NXT .

This checklist and consent form is not a substitute for reading the approved Product Information and for being familiar with the insertion and removal technique.

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The Royal Australian College of General Practitioners Ltd (RACGP) ABN 34 000 223 807
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