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EMERGENCY HORMONAL CONTRACEPTION PROFORMA (COSTELLO) AND ULIPRISTAL ACETATE (Elaine) See also NHS Fife supplementary guidance for oral ETC supply in Community Pharmacies (January 2016) http://www.communitypharmacy.scot.nhs.uk/nhs
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How to fill out emergency hormonal contraception proforma

01
To fill out the emergency hormonal contraception proforma, follow these steps:
02
Start by entering the patient's personal information, such as their name, date of birth, and contact details.
03
Indicate the reason for the emergency hormonal contraception, such as unprotected intercourse or contraceptive failure.
04
Specify the date and time of the incident.
05
Record any medications the patient is currently taking or any known allergies.
06
Document the patient's medical history, including any chronic conditions or previous pregnancies.
07
Assess the patient's risk factors and determine if emergency hormonal contraception is suitable.
08
Select the appropriate emergency hormonal contraception method and dosage.
09
Provide instructions and counseling to the patient regarding the chosen method.
10
Discuss the possible side effects and follow-up care.
11
Obtain the patient's signature and date to acknowledge their consent and understanding.
12
Finally, complete any necessary administrative tasks, such as billing or referral.
13
Ensure that the proforma is filled out accurately and legibly to maintain clear documentation.

Who needs emergency hormonal contraception proforma?

01
Emergency hormonal contraception proforma is required for individuals who:
02
- Have had unprotected intercourse
03
- Experienced contraceptive failure
04
- Wish to prevent an unintended pregnancy after a specific incident
05
- Seek immediate contraception due to a time-sensitive situation
06
It is recommended to consult a healthcare professional or a pharmacist to determine if emergency hormonal contraception is suitable.

What is EMERGENCY HORMONAL CONTRACEPTION PROA - (UPOSTELLE) AND ULIPRISTAL ACETATE (EllaOne) Form?

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Emergency hormonal contraception proforma is a form used to document the provision of emergency contraception to individuals.
Healthcare providers who prescribe or administer emergency hormonal contraception are required to file the proforma.
The proforma should be filled out with the patient's information, date and time of provision, type of emergency contraception provided, and any relevant notes.
The purpose of the proforma is to ensure proper documentation of emergency contraception provision and to track usage.
Information such as patient details, date and time of provision, type of emergency contraception, and any relevant notes must be reported on the proforma.
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