CIIC HC Special Conditions English
CHECK ALL THAT APPLYFor Users of the Pill, Patch, or Ring- You have special risk factors that may increase your chance of getting serious problems while using the pill, patch or ring. These special risk factors arebreast mass. If the mass is cancer, using the pill, patch or ring could cause the cancer to spread or make it more difficult to treat. It is very important that you go for the testing we recommended.diabetes (sugar)high blood pressureDiabetes and high blood pressure increase your risk for heart disease. So dobeing 35 or oldercigarette smokinghigh cholesterolhaving a father or brother with heart disease before age 55 and/or a mother or sister with heart disease before age 65at least two risk factors for heart diseaseblood clot in pastother __________________________________Be sure you understand the information we have given you. We are happy to answer your questions.For Users of POPs or the Implant- You have special risk factors that may increase your chance of getting serious problems while using POPs or the implant. These special risk factors arebreast mass. If the mass is cancer, using POPS or the implant could cause the cancer to spread or make it more difficult to treat. It is very important that you go for the testing we recommended.systemic lupus erythematosus (SLE) and you have antiphospholipid antibodies (or if you don’t know) you need to know thatThe hormone in the POPS or the implant could increase your risk of getting serious blood clots which could cause damage to your lungs, your heart, or your brain. Be sure you understand the information we have given you. We are happy to answer your questions.For Users of DMPA (Depo Provera, the Shot)- You have special risk factors that may increase your chance of getting serious problems while using DMPA. These special risk factors arebreast mass. If the mass is cancer, using DMPA could cause the cancer to spread or make it more difficult to treat. It is very important that you go for the testing we recommended.strokeheart attack or anginavascular diseasehigh blood pressureHigh blood pressure increases your risk for heart disease. So dobeing age 35 or oldercigarette smokingdiabetes (sugar)high cholesterolhaving a father or brother with heart disease before age 55 and/or a mother or sister with heart disease before age 65at least two risk factors for heart diseaseosteoporosis (thin bones)fragility fractures (broken bones because bones are weak)systemic lupus erythematosus (SLE) and you have antiphospholipid antibodies (or if you don’t know) or you have a very low number of platelets (severe thrombocytopenia)Using DMPA could increase your risk of getting serious blood clots which could cause damage to your lungs, your heart, or your brain. Or could lead to extra heavy bleeding. other _________________________________Be sure you understand the information we have given you. We are happy to answer your questions. ................
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