Request for antibiotic rescue pack

Please note that antibiotic rescue packs can only be provided to keep at home for certain chronic conditions and limited to certain patients who will know how to self manage their condition appropriately. A rescue pack is not appropriate for all patients with chronic disease. Please only fill out this form if your doctor or healthcare professional has previously supplied you with a home rescue pack and deem it necessary for you to have then at home for emergency use. Rescue packs must not be on your repeat medication list but can be requested each time you have needed to use one. If you are needing them very frequently, this means you need to have a review by the doctor to assess the severity of your illness or to look for other possible causes.

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Patient's Details
Rescue pack
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