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Emergency Hormonal Contraception Record there is safeguarding concerns the
completed form should be retained for 10
years or until the client is 25 years old,
whichever is longer. If over 18 or
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How to fill out emergency hormonal contraception record
How to fill out emergency hormonal contraception record
01
Obtain a copy of the emergency hormonal contraception record form.
02
Fill out the personal information section, including your name, date of birth, and contact information.
03
Answer the questions regarding your medical history, allergies, and current medications.
04
Indicate the date and time of the emergency hormonal contraception administration.
05
Provide details of the emergency, including the reason for the contraception and any relevant information.
06
Sign and date the form to certify the accuracy of the information provided.
07
Keep a copy of the completed form for your records and submit the original to the appropriate healthcare provider or organization.
Who needs emergency hormonal contraception record?
01
Emergency hormonal contraception record is needed by individuals who have undergone or will undergo emergency hormonal contraception.
02
This record is important for healthcare providers to ensure proper tracking, assessment, and follow-up care related to emergency hormonal contraception.
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What is emergency hormonal contraception record?
Emergency hormonal contraception record is a documentation tool used to track the dispensing and administration of emergency contraceptive methods to individuals seeking to prevent pregnancy after unprotected intercourse or contraceptive failure.
Who is required to file emergency hormonal contraception record?
Healthcare providers, including pharmacists and medical personnel, who dispense emergency hormonal contraception are required to file the emergency hormonal contraception record.
How to fill out emergency hormonal contraception record?
To fill out the emergency hormonal contraception record, enter the patient's information, the date the contraception was dispensed, the type of contraception provided, and the provider's details including signature and date of completion.
What is the purpose of emergency hormonal contraception record?
The purpose of the emergency hormonal contraception record is to maintain a reliable account of emergency contraceptive distribution, ensure proper tracking for public health monitoring, and facilitate follow-up care for patients.
What information must be reported on emergency hormonal contraception record?
The information that must be reported includes the patient's name, date of birth, date of service, type of emergency contraception provided, provider's name, and signature, as well as any relevant clinical notes.
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