The purpose of the Hormonal Contraception Victoria form is to support the resupply of contraception to patients in Victoria. 

Please note: This form was formerly named Oral Contraception (VIC)

Please follow these steps: 

• Select Patients in the menu.

• Search for the patient by surname, first name, address, medicare number or date of birth OR select from the Recently dispensed customers list OR select Add patient to manually enter the patients details

• Next to the patient's details, select Record Service

• View the Patient Information, including any patients notes, consultation history, medication list and more. Select the Services drop-down and select Hormonal Contraception Victoria

• Under Patient Information, make sure all compulsory fields are filled out e.g DOB and Sex

Please note: We recommend to update patient information in your dispense software

• Under Consulting pharmacist details, today's date is pre-populated but can be changed. Select your profile from the Pharmacist drop-down

•  Complete all compulsory fields in the PATIENT INFORMATION section.

Please note: We recommend to update patient information in your dispense software. 

•  Under PHARMACIST SUITABILITY you must select the check box to indicate that you have completed the required training.

You can also click the link to view the Protocol for Resupply of Hormonal Contraception Victoria

Please note: The system will remember this setting for each pharmacist, so you do not need to tick it each time.

• PATIENT CONSENT - The patient must provide informed consent to the service and the collection of their personal information. The patient consent recorded in the checkbox, must be taken as informed consent using points 1 and 2 in the Patient consent to treatment and privacy information sheet to support the discussion with the patient.  CLICK HERE to access the patient consent to treatment and privacy information factsheet. 

Please also tick all the additional demographics for pilot evaluation that apply to the patient.  There is also a requirement to select the patient payment status (e.g concessional or general) from the drop down, for reimbursement for the cost of medicines from the Victorian Government. 

• Complete the SCREENING QUESTIONS including all mandatory fields. Patients must be female and aged between 16-50 years old, they must be taking an approved drug as listed in the protocol and initiated on the approved drug by their GP to be eligible. 

Click here for the Protocol medicines list. This protocol is also available within the form. 

• If the patient meets the eligibility criteria, proceed to DRUG SELECTION. 

Please note: You must resupply the exact drug that the patient has previously been prescribed. 

• It is encouraged to check Blood Pressure and BMI and enter these details in the CLINICAL MEASUREMENTS section, if the patient is presenting for this service for the first time. If the patient is hypertensive or has a BMI greater than 35 it is recommended to refer the patient to the GP in the Treatment section. 

• Complete TREATMENT including Supply Quantity, which will default to re-supply. Make sure to answer all compulsory questions including Pharmacist administering injection on-site, as part of this consultation?

Please note: You must record any on-site injections by using the Admininistration of Injection form

You can also select Referral and enter the reason for the referral if required.

You can also generate a letter to give to the patient to share with the patients GP, if the patient consents. 

There is also a requirement to capture consent regarding accessing and reporting to My Health Record, if the patient consents

• Select the items completed as part of the NON-PHARMACOLOGICAL & WOMEN'S HEALTH ADVICE section including resources, general health advice and medication counselling sections. 

Please note: Click the links under resources for more information ensuring you remind the patient to see their GP and provide the patient with a hand-out.

Please note: If the patient does not meet the criteria for re-supply, please refer the patient to their GP.

• Complete REFERRAL and GP LETTER (as required with patient consent). A PDF will be generated. 

Please note: The form will indicate eligibility and other requirements based on your answers. 

• At the top and the bottom of the form, you can save a draft, delete or complete the form.