Forms Folder 1 (F1 to F50)
includes all 50 forms on USB
If you only want a couple of forms you can choose from those below. They cost £13.30+vat each and delivery is exclusively by email.
F01) Monitoring owings
The contract says you must monitor what has led to an owing being created.
What we have developed is a pre-printed sheet that you and your staff can record all information in a simple and quick way.
You then store these sheets, until a quiet period when you break down the data and do your report.
F02) Repeat dispensing audit trail - (requires a guillotine to cut to size).
The contract states that you have to know what items you have dispensed on each repeat occasion. This little form is attached to the master script and you can see at a glance where the patient’s dispensing is up to.
F03) Complaints procedure poster (A4) for the shop
You must have details of your complaints procedure, the name of your complaints manager, where the patient can get support whilst their complaint is ongoing and how the procedure works. This leaflet can be adjusted so that when you change staff or procedure it can be kept up to date with no added cost.
F04) Letter acknowledging a complaint received
This letter follows a standard format but can be personalised to the individual patient making them feel you are taking trouble with their complaint.
F05) Equipment Maintenance Forms
To ensure all equipment which requires monitoring is regularly checked.
All equipment within your pharmacy must be maintained regularly and the LAT will welcome a clear record of the equipment, who maintained and when.
F06) Referral form to cover any kind of referral
Obviously there are a number of areas when you will need forms to refer to various other health professionals for a variety of reasons. We have created one form that will cover all eventualities, so saving you time, money and storage space.
F07) EHC sale/supply showing the details of questions and breakdown of when EHC is not necessary.
This is an advanced form which took several months and many EHC patients to perfect. It serves as an aide memoire for the questions that you should ask in an interview. It is also has an advanced form that gives details of how many pills can be missed at various stages of the month before EHC becomes necessary.
F08) Record of counter advice given (with back up sheets) - (requires a guillotine to cut to size).
This is probably the most useful form. Under the new contract records of self care advice given must be maintained and if that advice is for a patient of yours that suffers from certain conditions, this advice must be recorded on their PMR.
Can you imagine how much time that is going to take your counter staff and the queue that will build up?
Our elegant solution is so simple you will wish you had thought of it. It will save you an enormous amount of time.
F09) Owing slips - (requires a guillotine to cut to size).
These are adjustable so that with each new LAT health promotion, you are advertising it via your owing slips. Impress the LAT or what!
F10) Alcohol Facts
Lists some interesting facts about alcohol. The computer file includes a calculator for working out the units in a given drink. The main body of the form shows the numbers of units contained in a wide variety of alcoholic drinks
F11) Recording Complaints
Under the new contract you must now follow a standard complaints procedure. This involves a strict timetable for investigation and resolution of the complaint. You must keep accurate records of all communications dealing with the complaint and if necessary report it to the NPSA. This form keeps a track of the events, with prompts, for when and how steps need to be taken.
F12) Error Recording Form
This will allow quick and easy recording of both dispensing errors and near misses. By using a simple tick box system it saves time and yet records all the necessary details.
F13) Health and Safety Risk Assessment
You are expected to check your premises on a regular basis to ensure that it is as safe as possible for both your staff and customers. This form lists most of the potential hazards within a pharmacy, with space to add more if necessary. By adding this is to your Health and Safety Manual you will have fulfilled this section of your legal requirements.
F14) Health and Safety Assessment of Electrical Items
Under the contract you must maintain all electrical equipment within the dispensary. Under Health and Safety you must ensure all electrical equipment is regularly assessed. This form lists all electrical equipment within your pharmacy. You simply record the make, model and serial number, when it was last checked and if it needs renewing etc. Again add this to your Health and Safety Manual so you build up the necessary checks.
F15) Recording Prescription Counts
One form is a paper based system, the other is computer based. With the computer based one, as you enter the figures the totals will be automatically calculated and at the end of the month a graph will be created to show you the trends.
F16) Problem / Query Follow up form
One of the problems in a pharmacy is when a query, either concerning a prescription or an OTC product that somebody has ordered, carries on over several days. Then the customer returns and nobody knows what has happened. By filling in this form with the original query and then each step that occurred along the way, you will be able to tell the customer/patient exactly what the situation is so far and what has been done to resolve the problem. This makes your pharmacy appear efficient and caring.
F17) MDS Fill Sheets
When making up MDS, it can be very easy to lose track of which tablets go in which compartments, whether you have scripts for all the tablets the patient should be on etc. This form simply keeps a track both in general and when actually making up the trays. There is a form for Dossette/Medidos and Venalink/Manrex systems.
F18) Drivers Drop Sheets
Again designed to provide a simple and quick system that records the name and address of the patient to be delivered to, with details of what is to be delivered, so items are not missed, and any messages that need to be passed on or collected from the patient. There is also space to record any goods delivered and monies collected. The second sheet in this section has a “Called but you were out” card, with room to advertise your services on the back.
F19) Collection / Delivery Control / Audit Sheet
This form allows you to keep track of a patient’s prescription from the time it is requested till the time it has been delivered. It is easy for a request to be lost along the way and then you have an irate patient on the phone asking where her/his prescription is. By filling in this form at every stage, you can tell the patient where it is with confidence. The two extra forms in this section, record all the pick ups from a particular surgery, for the driver to use. The last form records the details for each surgery, especially useful for a locum, not sure who he needs to contact at a particular surgery.
F20) Syringe and Needle Exchange Form
A form designed for you to keep track of the number and type of exchanges that are made in your pharmacy with comments about the clients health, behaviour etc. It can also be used to claim your payments from the LAT. This is much more professional looking than the constantly photocopied ones you may get from your local drugs clinic.
F21) CD Tally Sheets.xls
Under the new CD regulations it is now good practise and will eventually be compulsory for you to keep a running total or tally for each type and strength of CD that you stock. At the moment this can be kept physically but at a later date they must be maintained on computer.
F22) CD Stock take Record Sheet
At set intervals, depending on how often you dispense an item, you must check the actual stock against this running total. This form is for that count but if there is a discrepancy, it must be investigated. If you cannot resolve it, you must report it.
F23) CD Discrepancy Investigation.
This is used to record the investigation that is carried out within the pharmacy if a stock take reveals a discrepancy between the expected amount of a CD and the actual amount in the cabinet.
F24) Record of Controlled Drugs Destroyed
This form is so you can keep a check all CDs destroyed within your pharmacy both those returned by patients and those that are expired stock. This will help you have a clear audit trail of all CDs within your pharmacy.
F25) Adjustable letter to all GPs in the area re MUR service.
There are suggestions that some GPs are not happy about the MUR service being run in their area. This letter is intended to explain that the MUR is to help the patient with concordance and it is not a full medicine review. It focuses on how the MUR will help the surgery as well as the patient.
F26) Report on MUR money savings
This sheet is to keep a running total of all the financial savings the LAT could have achieved if your suggestions on the care plan had been taken up by the GPs.
F27) Medicine Reminder Chart
This is for you to fill in for your patients who have trouble remembering when they should take their tablets. This can be filled in for the patient or by the patient as a general reminder. In some cases this will be enough to help a confused patient by itself without going to the expense of a MDS.
F28) Smoking Cessation
This form is to be used for any patient joining your smoking cessation scheme.
The second sheet is for the patient to use to try to help them decide whether they really want to give up.
F29) Retail Price List and tips on calculations etc.
This form contains a “personalisable” range of items that can be sold over the counter but that tend to be kept in the dispensary and so have no retail price on them. The second form is to help you and your staff to calculate the percentage mark up you may decide to sell a product for and the profit on cost or on return that selling at the suggested retail price might give you.
As profit margins are one of the most vital parts of your business it’s important that all your senior staff, if not all your staff understand these concepts. It also helps you to manipulate VAT etc. It can be used to calculate in the computer.
F30) Root Cause Analysis Grid
When an error or near miss has occurred a root cause analysis has to be done – SOP on Vol 5 – and this form is to record the corrective action that has been decided upon to help prevent any of the contributory factors from happening again.
F31) RP absences
This sheet is a list of the jobs that can and can’t be done when the Responsible Pharmacist (RP) is absent.
F32) Records should be kept this long
This details the length of time various compulsory records that have to be kept before they can be destroyed
F33) Expiry Date Checking Sheets
This form is divided into sections of the dispensary e.g. generics A-G, F-M, M-Z with dates so that you can record which sections of your dispensary stock were last date checked. You then keep this record to show your inspectors. A quicker way is to put a dot on every item in your pharmacy on just one day of the month and then repeat with different coloured dots on the same date of the following months. After two months items will have 0,1,2, or 3 dots. Those with 3 dots you haven’t sold or dispensed in 2 months so don’t reorder and if possible sell off to ease cash flow.
F34) Complaints flyers and forms for public
This consists of two parts. Firstly the complaints flyer to give out to your clients and then forms for them to fill if they have comments, good or bad, they wish you to know about
F35) Annual Complaints Report Form
This is the form that you have to return to the LAT by the 31st of March of year to show how many complaints you received and the outcomes. It has to be completed and returned even if you had no complaints
F36 ) RP Display Certificate
This is the display certificate that you must have in easy sight of the public when you are operating as a RP. It is adaptable so if a locum turns up. Having forgotten his certificate you can make one for him.
F37) RP Absence Log
This sheet is to record dates and times of absences of the Responsible Pharmacist (RP). The allowance is for 2 hours out of 24 and the time runs from midnight to midnight. If the day is split between two or more RPs the allowance is still a combined two hours. There is space on the form to record the reason for the absence but it is not compulsory
F38) Staff Competency Forms
This is where you record the qualifications and duties of your staff at a certain date and must be available to incoming RPs to make comments on their performance and review other RP comments. If several different RPs have suggested a member of staff is not performing well the superintendent should make every effort to retrain that person until their performance is acceptable. It must be updated on a regular basis
F39) SOP amendments Audit Trail
This is where you record any changes that you have made to SOPs in the light of say a change in ownership, an incident or a change in the law. It states what the SOP said beforehand, what it has been changed to, why the change was made and space for staff member to sign to say they will follow the new arrangements.
F40) Locum Booking Form
These forms are to be completed when you book a locum, especially if they are new to you, telling them what their hours are, where your SOPs and RP logs are kept, any functions that are done before they arrive or after they leave which they might be responsible for etc.
F41) Anticoagulant Record
The form where you record the details that are required such as whether the patient has a yellow book, understands it, the last date their INR was checked etc. before you can dispense a prescription for an anticoagulant, particularly warfarin.
F42) Nursing Home Visit Checklist
Designed for those who still deal with nursing homes as an aide memoire of things that need to be checked in preparation for a CQC visit.
F43) Shop Layout Plan
You will need one of this to record your fire exits, fire extinguishers, assembly points, electrical points, etc. You then put this up on the shop floor so you and your clients can familiarise themselves with it.
44) Locum Invoice
A form your locums can use to claim the payments they think are due from you including mileage and parking. Do it on the computer and the calculations are done for you.
F45) Locum Feedback Form.
This is designed for your staff to quickly fill in after a locum has gone so you can consider whether you wish to re-employ them.
F46) Information Sheet for the Locum
This should record where your SOPs, RP log, CD keys are kept, passwords for the computer, any procedures that are performed before they arrive of after they leave for which they may be responsible for, contact numbers etc.
F47) Appraisal Guidance for Employees
This gives details of what your employees should do before their appraisal so get the most out of the exercise.
F48) Appraisal Guidance for the Appraiser
This gives you, the employer, ideas of how to run an effective appraisal which can form the basis of an action plan for you and the employee for the future
F49) Appraisal Form.
A form that is easy to complete for you and the employee with all the information on a single double sided sheet so it is easy to store.
F50) Job Descriptions
Details of the main jobs within a pharmacy – the pharmacy manager, dispenser, counter assistant, driver with clear lists of the areas they will have responsibility for and chains of command
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