New Hampshire Code of Administrative Rules
Ph - N.H. Pharmacy Board
Chapter Ph 2400 - PHARMACIST INITIATION AND DISPENSING OF HORMONAL CONTRACEPTIVES
Part Ph 2404 - PROCEDURES FOR PRACTICE
Section Ph 2404.01 - Initiation and Dispensing Procedure

(a) Provide each patient who seeks hormonal contraceptives with a board-supplied standardized information sheet, written in plain language, regarding the hormonal contraceptive being dispensed, which includes, but is not limited to:

(b) Have the patient complete an initial screening using the "Hormonal Contraceptive Self-Screening Questionnaire" dated November 17, 2021, available on the boards web site, https://www.oplc.nh.gov/board-pharmacy-forms-and-documents

(c) Have the patient complete any renewal screening identified through the use of the "Hormonal Contraceptive Self-Screening Questionnaire" dated November 17, 2021, available on the boards web site, https://www.oplc.nh.gov/board-pharmacy-forms-and-documents;

(d) Ensure each patient is an appropriate candidate for receiving hormonal contraceptives, as dictated by the U.S. MEC, U.S. SPR revised July 29, 2016, available as specified in Appendix B and the "Standard Procedures Algorithm for New Hampshire RPH Prescribing of Contraceptives", dated November 17, 2021 available on the boards web site, https://www.oplc.nh.gov/board-pharmacy-forms-and- documents, and refer to a health care practitioner, if appropriate;

(e) Identify the medication being dispensed to the patient and counsel the patient regarding, but not limited to, adverse effects, follow up appointments, and the instructions for use;

(f) Provide each patient with an "After Visit" summary sheet;

(g) Based upon a patient's request, provide electronically, in writing, or fax within 24 hours to the patient's primary care practitioner, or a pharmacist-referred practitioner if the patient does not have a primary care practitioner, a copy of the NH Self-Screening Questionnaire, the hormonal contraceptive that has been prescribed and dispensed to the patient, and any other relevant notes; and

(h) Based upon a patient's request, provide the patient who does not have a primary care practitioner and does not wish to be referred to a primary care practitioner a written copy of his or her record, which shall include, but not be limited to, the NH Self-Screening Questionnaire.