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Auckland DHB Haemophilia Centre

Public Service, Haematology

Factor Usage Reporting Form

It is important to record when you use Factor, either for prophylaxis or when treating a bleeding episode. This should be done every time you administer Factor. Failure to complete a monthly reporting form may put continuing home supply at risk.

People with Haemophilia managed by the Auckland DHB Haemophilia Centre are required to return a Factor Usage Reporting Form every month. This can be done either by completing a form by hand and sending it to the Centre, or electronically by completing the spreadsheet and emailing it to

A copy of the reporting form can be printed from this website or downloaded directly to your computer. Please see the Factor Usage Reporting Form link below.

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This page was last updated at 12:24PM on August 2, 2021.