For a minimum of 5 years, a pharmacy whose pharmacists prescribe contraceptives shall maintain documentation, in electronic or other form, which includes: The type of contraceptive prescribed, and dosage, if applicable, or the basis for not prescribing a contraceptive; The name, address, and date of birth of the patient; The name of the pharmacist who prescribed the contraceptive or determined a contraceptive would not be prescribed; The date the contraceptive was prescribed or that the patient was advised that a contraceptive would not be prescribed; A copy of the patient’s visit summary; A copy of the patient’s self screening risk assessment questionnaire; and The name and address of the: Patient’s primary care practitioner or reproductive health care practitioner, if provided by the patient; or Family planning provider or licensed clinician who provides reproductive health care services referred by the pharmacist, if the patient does not have a primary care practitioner or reproductive health care practitioner.