Fillable Printable Esap Material Order Form 7-6-16
Fillable Printable Esap Material Order Form 7-6-16
Esap Material Order Form 7-6-16
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New York State Department of Health AIDS Institute
HIV/AIDS EDUCATION & PREVENTION MATERIALS ORDER FORM SUPPLEMENT
Expanded Syringe Access Program (ESAP) Materials
1. Please circle only one quantity per item.
Title Language Code # Quantity (Circle one)
Required ESAP Safety Insert – ESAP (Expanded Syringe Access
Program) providers are required by New York State Public Health Law
to distribute a copy of this flier with each sale of syringes to customers/
clients. (Flier) English 10/15; Spanish 9/15.
Also available on the web at:
www.health.ny.gov/publications/9359.pdf
www.health.ny.gov/publications/9360.pdf.
English 9359 100 300 600
Spanish 9360 100 300 600
Be Aware, Don’t Share – Urges injecting drug users to quit or to get
new needles and syringes through ESAP to reduce the risk of becoming
infected with HIV, hepatitis B, or hepatitis C. (Brochure) English 10/15;
Spanish 3/13.
English 9405 50 100 200
Spanish 9406 50 100 200
Be Aware, Don’t Share – This 11” x 17” poster is a companion piece to
the brochure of the same name promoting risk reduction through ESAP.
(Poster) English 5/13; Spanish 5/13.
English 9420 50 100 200
Spanish 9421 50 100 200
Safe Sharps Disposal – Provides persons using needles, syringes, and/or
lancets (sharps) at hom e wit h inf ormation about safe storage and di sposal
of used sharps. (Brochure) English 2/13; Spanish 3/13.
Also available on the web at:
www.health.ny.gov/publications/0909.pdf
www.health.ny.gov/publications/0941.pdf
English 0909 50 100 200
Spanish 0941 50 100 200
What Does YOUR Needle Look Like? – Displays photos showing how
needle points quickly become worn after being used more than once.
It urges readers to use new needles and syringes every time and lists
contact information for ESAP and syringe exchange programs.
(Brochure) English 7/11; Spanish 7/11. English temporarily out of stock;
can be downloaded from: www.health.ny.gov/publications/9508.pdf
English 9508 50 100 200
Spanish 9509 50 100 200
Diabetes? – Thi s br ochure is geared toward diabetics who self-inject insulin.
Patients can buy new buy new syringes without a prescription . It explains
how to safely dispose of used syringes. (Brochure) English 2/13;
Spanish 3/13.
English 9458 50 100 200
Spanish 9459 50 100 200
the Point - Postcard promoting the Point, a site locator tool developed for
the purpose of finding locations statewide and/or near you where you can
obtain hypodermic needles and syringes without a prescription, as well as
locations where syringes and drugs can be disposed safely in secure and
anonymous drop boxes (kiosks).
English 0102 50 100 200
NEW
Stay Healthy and Survive -- This brochure lists the steps for cleaning and
bleaching drug injection equipment to lower the risk of transmitting HIV.
It lists the Syringe Exchange Program (SEPs) sites where you can
exchange old needl es fo r new ones (Brochure). 3/15.
English 9160
50 100 200
Spanish
(11/15)
9161
How to Safely Dispose of Household Sharps – This stand-alone cardboard
desktop display has photos and explains how to safely dispose of household
sharps. Not available in PDF format. (11” x 17” cardboar d eas el ). 9/1 5.
English 9464 50 100 200
Spanish 9465
A Step-by-Step G uide for Your Pharmacy – Provides pharm aci st s wit h
an easy-to-use reference guide for implementing ESAP. The guide can be
used to train staff in the key elements of ESAP and provides in formation
about helpful resources. (Pamphlet) 4/08.
English 9457
1 5 10
Instructions for Orderin
g
Bulk Materials within New York State
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2. Please complete the address label on the next page. Be sure to print clearly. ALL orders must include a
street address. Bulk orders will not be delivered to post office boxes.
3. Mail orders to: New York State Department of Health,
Distribution Center, P.O. Box 343, Guilderland, NY 12084-0343
4. A minimum fee to cover production, shipping and handling costs will be charged for Out-of-State orders.
Orders may not be picked up at the Distribution Center.
Bulk orders cannot be delivered to post office boxes. Please be sure to include a street address on the
mailing label below.
A packing slip will be included with all materials shipped. Materials ordered that are temporarily out of
stock will be noted on the packing slip. Please note that out-of-stock materials will not be back-ordered.
You are asked to please re-submit your order in four (4) to six (6) weeks.
ADDRESS LABEL:
Complete and return to NYSDOH Distribution Center
NAME
ORGANIZATION (if applicable)
STREET
CITY STATE ZIP
Rev. 10/16
A Guide f or Phar macists and Staff in ESAP-Registered Pharmacies –
Companion reference card to A Step-by-Step Guide for Your Pharmacy
(Laminated card). 4/08 .
English 9469 1 5 10
Directory of Registered ESAP Providers – This registry lists ESAP-registered providers in all counties in New York State and
each borough in New York City: www.health.ny.gov/diseases/aids/consumers/prevention/needles_syringes/esap/provdirect.htm.
Directories of
Sharps Disposal Sites – These directories list all the facilities and alternative collection sites that dispose of used
needles and syringes: www.health.ny.gov/sharps-collection.
Delivery
