Get Pep Drug Replacement Form. Form To Request Replacement Post Exposure Prophylaxis Drugs. - Health
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How to fill out the PEP Drug Replacement Form. Form To Request Replacement Post Exposure Prophylaxis Drugs. - Health online
This guide provides comprehensive instructions for filling out the PEP Drug Replacement Form, used to request replacement drugs for post-exposure prophylaxis (PEP). By following these steps, users can ensure accurate and complete submissions to facilitate the dispensing process.
Follow the steps to fill out the PEP Drug Replacement Form accurately.
- To obtain the form, press the ‘Get Form’ button to download and open it in your digital document editor.
- Fill in the patient code, which consists of the first two letters of the last name followed by the first name, and provide the age of the individual receiving PEP.
- Indicate the individual’s gender by checking the appropriate box: Male, Female, or Other.
- Provide the UR number as required by the pharmacy for processing.
- Enter the current residential postcode of the patient.
- Indicate whether the individual has taken PEP in the past 12 months by selecting ‘Yes’ or ‘No’.
- If the person resides outside of Australia, specify the country of residence.
- Complete the exposure details by indicating the time since exposure in hours and describing the type of exposure: sexual contact or shared injecting equipment.
- Specify if condoms were used during the exposure event.
- If known, provide details on the source partner’s gender, HIV status, antiretroviral use, and any associated risk characteristics.
- Indicate if a starter pack was dispensed and specify the type if applicable.
- Confirm whether four weeks of PEP was prescribed and note the name of the consulting physician.
- Fill in the details about the drugs prescribed, dosage, duration, and information from the authorized prescriber.
- Finalize the form by including the pharmacist’s details, including name, signature, and date.
- Submit the completed form via email or fax to the dispensing pharmacy and ensure it is sent to the required health department.
Complete your documents online to ensure timely processing and support.
The following is recommended by CDC for PEP: TDF (300 mg), FTC (200 mg) once daily, RAL 400 mg twice daily or dolutegravir (DTG) 50 mg daily. TDF 200 mg, FTC (300 mg) once daily, RAL 200 mg twice daily or DTG 50 mg daily. FTC (200 mg) once daily, RAL 400 mg twice daily or DTG 50 mg daily.
Fill PEP Drug Replacement Form. Form To Request Replacement Post Exposure Prophylaxis Drugs. - Health
Non-Occupational HIV Post-Exposure Prophylaxis - Drug Replacement Form. Please complete this form for each person who has been prescribed PEP. 1. PEP refers to the use of HIV medicines to prevent HIV infection within 72 hours (3 days) after a possible exposure. Instructions: Patient should complete Part A and return to custodian before PEP kit is given to the patient. Please see the following pages for the HIV PEP Kit Replacement Form. PEP (or postexposure prophylaxis) involves taking antiHIV drugs very soon after a possible exposure to HIV to prevent HIV. Health care provider should offer presumptive treatment for STI after explaining the risks and benefits and obtaining informed consent from the survivor. PEP (post-exposure prophylaxis) means taking medicine to prevent HIV after a possible exposure. PEP Must Be Started Within 72 Hours of Possible Exposure to HIV.
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