COPEÂ® FOR MALE CIRCUMCISION SERVICES - EngenderHealth

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COPE for Male Circumcision Services Client Record-Review Checklist for Male Circumcision Services (continued) Site: _______________________ Reviewer: _______________________ Date: _______________________ Checklist Item 1 2 3 4 5 6 7 8 9 10 Total Answered Negatively Remarks Adverse events during operation Adverse event rating (e.g., mild, moderate, severe) Circumcision Follow-Up Visit Date of visit Type of visit (e.g., routine, client-initiated) Adverse event symptoms (if yes, ensure that Adverse Event Form is completed and see Adverse Event Section below). Follow-Up Visit Date of visit Type of visit (e.g., routine, client-initiated) Adverse event symptoms (if yes, ensure that Adverse Event Form is completed and see Adverse Event Section below). Adverse Event during Circumcision Date of visit Date MC completed Theater registration no. (continued) 64 <strong>EngenderHealth</strong>
COPE for Male Circumcision Services Client Record-Review Checklist for Male Circumcision Services (continued) Site: _______________________ Reviewer: _______________________ Date: _______________________ Checklist Item 1 2 3 4 5 6 7 8 9 10 Total Answered Negatively Remarks Adverse event (including description and severity) Total maximum severity, based on all adverse events recorded Treatment provided Adverse Event Postcircumcision Date of visit Date MC completed Theater registration no. Adverse event (including description and severity) Total maximum severity, based on all adverse events recorded Treatment provided Additional comments on client record review: <strong>EngenderHealth</strong> 65
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COPE ® FOR MALE CIRCUMCISION SERVI
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© 2010 EngenderHealth. All rights
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List of Figures Figure 1. The Right
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spirit of COPE is based on the noti
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Acronyms and Abbreviations AIDS CFA
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COPE for Male Circumcision Services
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Page 27: Self-Assessment Guides for Male Cir
Page 30 and 31: COPE for Male Circumcision Services
Page 33 and 34: Clients’ Right to Access to Servi
Page 35 and 36: ■ Plain gauze swabs (10 10×10 cm
Page 37 and 38: Clients’ Right to Informed Choice
Page 39: COPE for Male Circumcision Services
Page 53 and 54: Clients’ Right to Continuity of C
Page 65 and 66: Staff Need for Supplies, Equipment,
Page 69 and 70: Finally, disposable consumables for
Page 71: Client Record-Review Checklist for
Page 79: Client Interview Guide for Male Cir
Page 87: Client-Flow Analysis Forms for Male
Page 93: Action Plan and Follow-Up Forms for
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COPEÂ® FOR MALE CIRCUMCISION SERVICES - EngenderHealth

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