EC Service Materials

A variety of printed materials are available to help you provide EC services to your clients. Many of these materials are available in other languages. Most of these materials can be downloaded from this Web site. Other materials must be ordered from us. Please click the links below to view, download or order materials.

  • Mandated EC Fact Sheet
  • EC Encounter Form
  • EC Consent Sheet
  • Instructions for EC Use
  • Starting Ongoing Contraception after EC Use
  • EC Services – Staff Announcement Flyer
  • Order Form (PDF-60K)
Title (click to view)
Description & Usage
Mandated EC Fact Sheet

  • English (PDF-64K)
  • Armenian (PDF-1MB)
  • Cambodian (PDF-1.7MB)
  • Chinese (PDF-936K)
  • Farsi (PDF-832K)
  • Hmong (PDF-496K)
  • Korean (PDF-1MB)
  • Russian (PDF-752K)
  • Spanish (PDF-64K)
  • Tagalog (PDF-572K)
  • Vietnamese (PDF-992K)
 Pharmacists are mandated by CA state law to provide a fact sheet approved by the CA State Board of Pharmacy to each woman receiving EC.

Revised in July 2004

Armenian added, March 2005
EC Encounter FormNew Short Form

  • English: Editable Document (52K) | PDF (20K)
  • Spanish: Editable Document (56K) | PDF (16K)

Revised Long Form

  • English: Editable Document (36K) | PDF (20K)
  • Spanish: Editable Document (36K) | PDF (20K)
 An optional form the client fills out at the beginning of the EC encounter to help the pharmacist obtain key information to provide EC and maintain appropriate documentation.

Available in two versions: a new short form for fast service, and a revised longer form that assists pharmacists in making referrals for ongoing contraception and STI/HIV services.
EC Consent Sheet

  • English: Editable Document (40K) | PDF (24K)
  • Spanish: Editable Document (44K) | PDF (20K)
 An optional form designed for the retail pharmacy setting.

 
Instructions for EC Use

  • English: Editable Document (44K) | PDF (20K)
  • Cambodian: PDF (928K)
  • Chinese: PDF (608K)
  • Hmong: PDF (236K)
  • Korean: PDF (420K)
  • Spanish: Editable Document (44K) | PDF (24K)
  • Tagalog (Filipino): PDF (308K)
  • Vietnamese: PDF (620K)
 An optional form that provides helpful information regarding dosing and timing of EC.

Can be given to women to take home as additional source of information.
Starting Ongoing Contraception after EC Use

  • English: Printer-Friendly Page | PDF (20K)
  • Spanish: Printer-Friendly Page | PDF (16K)
 Provides EC clients with information on appropriate use of other birth control methods after EC.
EC Services – Staff Announcement Flyer

  • PDF (436K)
 One-page reference sheet to alert and educate pharmacy store staff about EC services provided in a pharmacy to the public.

Created to alleviate confusion among store staff, or other pharmacists about EC services provided.

Display in an area that is visually accessible to all store staff and/or make copies for distribution. Space included to indicate which pharmacist(s) at the store provide EC and if there is on-call service available.