1. (a) A pharmacist engaging in the initiation and dispensing of hormonal contraceptives shall maintain patient records for a minimum of 7 years.

2. (b) Maintained patient records shall, at a minimum, include:

   1. (1) The name and date of birth of the patient;
   2. (2) A copy of the “Hormonal Contraceptive Self-Screening Questionnaire” dated November 17, 2021, completed by the patient;
   3. (3) Evidence that the patient was screened;
   4. (4) Counseling information relayed to patient;
   5. (5) Based upon patient request, evidence that the practitioner was provided with the self- screening questionnaire and notified of the drug dispensed;
   6. (6) Name, dose, strength, quantity, and directions of the hormonal contraceptive dispensed; and
   7. (7) Signature of the patient.

Source. #13343, eff 2-17-22