Victorian Numbered Regulations

PUBLIC HEALTH AND WELLBEING REGULATIONS 2019 (SR NO 135 OF 2019) - SCHEDULE 6

Schedule 6—Anaphylaxis—prescribed notification details

Regulation 102

        Item 1—Notification details—case information

    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)

Item 2—Notification details—clinical information

    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.

Table

Column A Suspected cause of anaphylaxis	Column B Additional notification details
Consumption of packaged food	Type of food product Brand of food product Date and time of consumption
Unpackaged food from a food premises	Details of the food consumed Name of food premises Date and time of consumption
Consumption of any other food	Details of the food consumed
Drug	Type of drug Name of drug
Blood-derived products	Name of product Batch number
Vaccine	Type of vaccine Name of vaccine Expiry date of vaccine (if known) Batch number of vaccine (if known)
Insect venom	Type of insect
Other	Details of the suspected cause of anaphylaxis
Unknown	Any relevant details