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Health Care Provider STBBI medication orders

Order and pick-up instructions

Napanee based orders

Napanee orders need to be submitted by noon on Wednesday to be ready for pick-up at the Napanee office the following week.
Napanee office pick-up available Monday 1:00 to 4:30 pm and Tuesday to Friday 8:30 am to 12:00 pm and 1:00pm to 4:30pm.

Kingston based orders

Orders will be ready 72 hours after the order is placed. Kingston office pick up available Monday to Friday 8:30am to 4:30pm.

You may place your order now. All orders will be processeed as soon as product is available.

Please note that in some instances it may take longer than 72 hours to be processed, due to the approval process.

Name of facility, physician, or practice

Phone number (999-999-9999)

Email address (we will send you a copy of this order for your records)

Approximate number of patients in practice

Main fridge code

Do you currently have an order placed for a special order vaccine or medications?

Yes

STI Drug(s) you would like to order

Please check all that apply

Azithromycin 250 mg tabs

1 treatment consists of 4 tablets, for a total of 1g

There are 6 tabs per package (1.5 treatments per package)

I would like to order Azithromycin, 250mg tabs (Maximum order of 6 packages, which equals 9 doses)

Yes

Penicillin G Benzathine-Long Acting (Bicillin L–A)

One treatment is 2 syringes - each syringe contains 1,200,000 (1.2 million) units per 2 ml, for a total of 2,400,000 (2.4 million) units (4 ml total)

Short acting Penicillin agents (such as Penicillin G) are not adequate to treat syphilis.

I would like to order Bicillin, 2,400,000 (2.4 million) units for the treatment of Syphilis. MAXIMUM ORDER OF 4 TREATMENTS (8 syringes).

Yes

Ceftriaxone

One treatment consists of 2 vials, with each vial containing 250mg, for a total dose of 500mg per treatment.

* Lidocaine diluent will be provided with this order. If you require sterile water diluent for a patient who is allergic to lidocaine, please contact us at 613-549-1232, ext. 2000 (Inventory)

I would like to order Ceftriaxone (MAXIMUM ORDER OF 10 VIALS)

Yes

Requested delivery method (Please select one)

Pick-up by ordering office (please bring hard-shell cooler, cooled to between 2 to 8°C)

Courier pick up, to be arranged by ordering office with their preferred courier (please send hard-shell cooler, cooled to between 2 to 8°C)

Delivery by courier, arranged by KFL&A Public Health

Comments or further details

By checking this box, I acknowledge I have read, understand, and agree the information provided in this form is correct

Yes