Getting Contraceptives to the Client

Daily Activities Register				Month/Year	/
Daily Activities Register				Page	of
Client Data	Date					t o t a l o f p a g e	p r e v i o u s p a g e	m o n t h l y t o t a l
	Client Number
	Client name
	New
	Continuing
Quantity of Contraceptives Distributed	Oral Contraceptives		Lofem
			Other
			Other
	IUD		CT 380
	IUD		Other
	Barrier Methods	Condoms	Sultan
		Condoms	Other
			Diaph.
			Jelly
		Foam	Can
		Foam	Tablets
	Injectables		Depo- provera
	Injectables		Noristerat
	Implants		Norplant
	Implants		Other
	Sterilizations		Masc.
	Sterilizations		Fem.