R433-200-3. Protocol For Issuance of a Standing Prescription Drug Order

  Each standing prescription drug order for self-administered hormonal contraceptives issued under the Act shall adhere to the requirements of Section 26-64-105. In addition, each order shall also require the following:

  (1) Persons authorized to initiate dispensing a self-administered hormonal contraceptive shall make and retain a record that includes the following information:

  (a) The age and zip code of each patient receiving a self-administered hormonal contraceptive;

  (b) The NDC of each self-administered hormonal contraceptive dispensed;

  (c) An annual count of the number of patients who provide their self-screening risk assessment for evaluation by the pharmacist or pharmacist intern; and

  (d) Any other relevant information required by the physician's standing order.