• 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

New 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.

• English: Editable Document (40K) | PDF (24K)
• Spanish: Editable Document (44K) | PDF (20K)

An optional form designed for the retail pharmacy setting.

• 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.

• 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.

• 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.