Sch 6Anaphylaxis—prescribed notification details

Schedule 6—Anaphylaxis—prescribed notification details Regulation 102 1.1 Family name 1.2 Given name(s) 1.3 Date of birth 1.4 Sex 1.5 Aboriginal or Torres Strait Islander status 1.6 Residential address 1.7 Contact details of the person/parent(s)/guardian(s) 2.1 Mortality details 2.2 Morbidity details 2.3 Allergies or other history of anaphylaxis reported by the person 2.4 Date of presentation for treatment for anaphylaxis Item 3—Notification details—details of anaphylaxis reporting body 3.1 Name and address of anaphylaxis reporting body 3.2 Telephone number and email address of anaphylaxis reporting body 3.3 Name and telephone number of registered medical practitioner who formed the reasonable belief that the person had anaphylaxis 3.4 Report date Item 4—Notification details—suspected cause of anaphylaxis The notification details are to include one of the causes listed in column A of the Table as the suspected cause of the anaphylaxis of the person presenting for treatment, and the details in column B of the Table to the extent known to the anaphylaxis reporting body. | *Column A*<br>*Suspected cause of anaphylaxis* | *Column B*<br>*Additional notification details* | | Consumption of packaged food | Type of food product<br>Brand of food product<br>Date and time of consumption | | Unpackaged food from a food premises | Details of the food consumed<br>Name of food premises<br>Date and time of consumption | | Consumption of any other food | Details of the food consumed | | Drug | Type of drug<br>Name of drug | | Blood-derived products | Name of product<br>Batch number | | Vaccine | Type of vaccine<br>Name of vaccine<br>Expiry date of vaccine (if known)<br>Batch number of vaccine (if known) | | Insect venom | Type of insect | | Other | Details of the suspected cause of anaphylaxis | | Unknown | Any relevant details |