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Pharmacy Stamp EMERGENCY HORMONAL CONTRACEPTION RECORD FORM This form is to be completed on each occasion the ETC National Enhanced Service is provided. Does the patient have severe hepatic dysfunction?
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How to fill out emergency hormonal contraception record

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How to fill out an emergency hormonal contraception record:

01
Start by gathering all the necessary information such as the patient's name, date of birth, and contact information.
02
Next, verify if the patient is eligible for emergency hormonal contraception. This may include checking if they meet certain age requirements or if they have had unprotected sex within a specific time frame.
03
Document the date and time of the consultation or visit where the emergency hormonal contraception was prescribed.
04
Record the reason for prescribing the emergency hormonal contraception. This can include details such as unprotected intercourse, contraceptive failure, or sexual assault.
05
Document the specific type and dosage of emergency hormonal contraception that was prescribed.
06
If applicable, note any important instructions or information provided to the patient regarding the usage and potential side effects of the emergency hormonal contraception.
07
Finally, ensure that the emergency hormonal contraception record is signed and dated by the healthcare professional responsible for prescribing it.

Who needs an emergency hormonal contraception record?

01
Women or individuals with a uterus who have had unprotected sex or contraceptive failure.
02
Individuals who have experienced sexual assault and are seeking emergency hormonal contraception as a preventative measure.
03
Patients who have had contraceptive method failure, such as a condom break or a missed contraceptive pill.
Please note that it is essential to consult with a healthcare professional or a pharmacist for accurate instructions and advice regarding emergency hormonal contraception.
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Emergency hormonal contraception record is a document that records the use of emergency contraception by an individual.
Healthcare providers are required to file emergency hormonal contraception record.
To fill out emergency hormonal contraception record, healthcare providers must input the patient's information, the emergency contraception administered, and the date and time of administration.
The purpose of emergency hormonal contraception record is to track the use of emergency contraception and ensure proper documentation.
Information such as patient demographics, type of emergency contraception administered, dosage, date and time of administration, and healthcare provider information must be reported on emergency hormonal contraception record.
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