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Give one example

This is a Planned Parenthood clinical record form for Permanent Family Planning Methods, used in nursing/midwifery practical training. It documents either a Tubectomy (female sterilization) or Vasectomy (male sterilization) procedure.
Here is a filled example for Tubectomy:
PLANNED PARENT HOOD Permanent family planning method (Assisted/Observed) - 1
a) Tubectomy ✓
  • Name of the Client: Sunita Devi --- Registration No.: FP/2026/0042
  • Age: 28 --- Religion: Hindu --- Education: Secondary --- Occupation: Homemaker
  • Husband's name: Ramesh Kumar --- Age: 32
  • Education: Higher Secondary --- Occupation: Farmer
  • No. of children: 3 --- Male/Female: 2M / 1F --- Age of children: 6 yrs, 4 yrs, 1 yr
  • Consent taken from: Wife/Husband ✓
  • Date of procedure: 10/07/2026
  • Brief description of procedure: Minilaparotomy tubectomy performed under local anesthesia with sedation. Both fallopian tubes identified and ligated using the Pomeroy technique (a loop of each tube tied and excised). Procedure completed without complications. Patient observed for 2 hours post-op and discharged in stable condition with follow-up advice.
Key points about Tubectomy (for your record/exam):
  • It is a permanent female sterilization method
  • Most common technique: Pomeroy's method (ligation and resection of fallopian tubes)
  • Done via minilaparotomy or laparoscopy
  • Consent of the woman (and ideally spouse) is mandatory
  • Failure rate: ~0.5% (very effective)
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