The state health officer may prescribe on a statewide basis a self-administered hormonal contraceptive by one or more standing orders in accordance with a protocol consistent with the United States Medical Eligibility Criteria for Contraceptive Use (MEC) Centers for Disease Control and Prevention, that requires:
(1) Use of the self-screening risk assessment questionnaire described below;
(2) Written and oral education;
(3) The timeline for renewing and updating the standing order;
(4) Who is eligible to utilize the standing order;
(5) The pharmacist to make and retain a record of each person to whom the self-administered hormonal contraceptive is dispensed, including:
(A) The name of the person;
(B) The drug dispensed; and
(C) Other relevant information.