STI Medication Ordering

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The Leeds, Grenville and Lanark District Health Unit provides publically funded STI medications to all community health care providers. Medications can be ordered to keep in stock at your clinic location or ordered on a case by case basis to treat patients.

STI medication orders and vaccine orders will be ready for pick up together. Orders are processed every 4 weeks and must be received by 4:30pm on Thursday on the date indicated on the vaccine ordering and delivery schedule. Pick up dates and times for each of our Health Unit offices is based on hours of operation at that site. We need time to process and pack orders in our Brockville location, and send out to our other Health Unit sites. For questions or concerns, please email [email protected].

Please ensure you bring a conditioned cooler with you for transportation of Penicillin G Benzathine (Bicillin).

For more medication fact sheets and sexual health information, please visit the sexual health section of our website.

STI Medication Ordering Form

Name of Health Care Provider Location *Please insert your official facility name used by MOHLTC(Required)

Date of Request(Required)

Contact Person(Required)

First Name Last Name

Phone(Required)

Fax

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Special Instructions

Type of Request(Required)

Routine order as per order cycle

Urgent - Must Pick up in Brockville or Smiths Falls

Health Unit Office/Service Site(Required)

Health Unit Office/Service Site for Urgent Orders(Required)

Available STI Medications for Order(Required)

Azithromycin 250mg - 6 tablets per box (1.5 doses/box)

Doxycycline 100mg

Ceftriaxone 250mg with 1% Lidocaine 0.9ml

Cefixime 400mg

Penicillin G Benzathine (Bicillin) 2.4 million units in divided syringes

Holding Point Number - see yellow sticker on vaccine fridge(Required)

LGL_BR_00###

Azithromycin 250mg Select Quantity(Required)

6 tabs per box (1.5 doses/box)

Doxycycline 100mg Select Quantity(Required)

Ceftriaxone 250mg with 1% Lidocaine 0.9ml Select Quantity(Required)

*Lidocaine dilutant will be provided with each dose of Ceftriaxone ordered*

Cefixime 400mg Select Quantity(Required)

Penicillin G Benzathine (Bicillin) 2.4 million units in divded syringes Select Quantity(Required)

Penicillin G needs to be refrigerated at all times to maintain its cold chain (2-8 degrees Celsius)

By checking this box, I attest that this medication will be stored in a Health Unit inspected and monitored fridge.(Required)

I agree

Consent and Tracking(Required)

By checking this box, I understand and consent to utilizing these medications for their intended purposes of treatment of STI's and agree to tracking administration, treated infection, expiration and wastage.

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