RACF Influenza Antiviral Treatment

Facility

First name of nominated authorised person

Last name of nominated authorised person

Authorised persons are the Manager, Care Manager, Director of Nursing, Nursing Unit Manager, Operations Manager or any person assigned with the role of managing a residential facility.

Facility address (NSW only)

Street addressStreet address line 2

City

Postcode

Urgent/same day delivery required

YesNo

Please indicate if there are any special delivery requirements

Opening hours

Phone

Influenza antiviral treatment

Number of treatment courses required (1 course = 10 doses)

Please contact your local public health unit on 1300 066 055 to arrange orders of Tamiflu over 250 courses.

Treating primary care clinician (GP/ NP) consulted

YesNo

The pre-placed Tamiflu can only be used for residents of aged care facilities following prescription by an authorised prescriber.

Lab confirmed influenza diagnosis

YesNo

Symptom onset date

PHU notified of outbreak

YesNo

Please call your local Public Health Unit to notify them of the possible outbreak on 1300 066 055.

Confirm renal function reviewed prior to administration Oseltamivir (Tamiflu)

YesNo