Provision of Medical Services Related to Family Planning Sample Policy Template

Job Aid
Referrals and Linkages Title X Family Planning Program
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Title X projects must provide for medical services related to family planning (including consultation by a clinical services provider, examination, prescription and continuing supervision, laboratory examination, and contraceptive supplies), in person or via telehealth, and make necessary referrals to other medical facilities when medically indicated, and provide for the effective usage of contraceptive devices and practices. This sample policy template can be modified with agency or site-specific information.

This tool is part of “Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers” which supports Title X grantees’ ability to provide effective referrals to meet the needs of their clients.