F51) Staff Training Record Sheet

For recording training requirements of individual members of staff and details of their training.

F52) Confidentiality Clauses

Confidentiality agreements for companies and third parties you work with who have access to Patient Identifiable Information, with forms to record their details. 
F53) Methotrexate Toxicity Symptoms

Symptoms of Methotrexate Toxicity with warnings and recommendations. 
F54) Lithium Toxicity Symptoms

Symptoms of Lithium Toxicity with warnings and recommendations. 
F55) Hand washing during risk of Pandemic

Detailed guide on hand washing during a pandemic to display in your shop.
F56) CD leaflet for the patient

Patient Information leaflet with recommendations for storage and use of Controlled Drugs.
F57) Near Misses Report

For recording outcomes of meetings where Near Miss or Dispensing Errors have been discussed and solutions for error prevention have been agreed. 
F58) Emergency Contacts Sheet

For recording Emergency Contacts details (e.g. Electricians, Locksmiths, Emergency Services).
F59) Assignment sheets for data protection senior staff

For recording details of all Data Security and Protection staff.
F60) Staff Data Protection Questionnaire

Questionnaire to determine staff awareness and knowledge of Data Security and Protection protocols.

F61) Blood Pressure Request Form 

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F62) Record of Patients Spoken to About Their BMI

Data collection for patients spoken to about their BMI (includes calculations & size/weight converter).
F63) Record of Referrals to Local Authority Weight Management Services

Record of referrals of the number people to local authority funded tier 2 weight management services or 'NHS Digital Weight Management Programme'.
F64) Hypertension & Diabetes Patients Referred to NHS Weight Management

For keeping track of patients with hypertension or diabetes who have been referred to the 'NHS Digital Weight Management Programme'.
F65) Weight Management Support Groups

For recording contact information of local weight management support groups so you can refer patients easily.
F66) Record of Local and National Campaigns on Health Related Topics

For keeping a diary of health promotions. 
F67) Signposting (a, b & c)

For collecting contact information of organisations providing patient services (a), organisations that the pharmacy could engage with for health promotion (b), local clinical commissioning groups (c).
F68) NMS Audit Trail

For recording and keeping a check on patients who have agreed to NMS, the dates of engagement, intervention and follow up discussions, advice given and results/outcomes of the service. 
F69) Patient Leaflet on NMS

Information leaflet to pass to patients explaining what the service is about and how it can help them.
F70) Record of Advice Given & Referrals Made for Follow Up Care

For recording outcomes of the service, with patient and referral details. 

F71) Job Advert (a) & 'Skills We Are Looking For' (b)

Template for a job advertisement when recruiting new staff. Fully customisable.

'Skills We Are Looking For' allows you to list the skills required for different job roles within the pharmacy, to refer to when advertising for new staff. 

F72) Job Application Form

Simple application form to email to potential employees, with space for any previous education, qualifications and employment details. 

F73) Interview Time Sheet

For recording one day's schedule of interviews, with space for any notes about each candidate. 

F74) Rejection Letters

Rejection letter templates for informing candidates they were unsuccessful. Three different templates for each stage of the recruitment process (for candidates who sent cv, attended interview or had interview cancelled). 

F75) Staff Duty Rota

Weekly rota for assigning tasks to staff members on specific days. 

F76) Staff Holiday Form

For recording staff holiday details. Form on USB allows you to add or remove employees and automatically calculates how many days each member of staff has left. There are also links to the Gov.UK holiday entitlement calculator and bank holiday information for the current year. 

F77) Return to Work Form

For recording a brief summary of the 'back to work' interview, after an employee has been absent, with space for any future actions or improvements to be made. 

F78) Violent Incident Record Form (a) & 'Zero Tolerance' Poster (b)

For recording any violent or aggressive incidents in the shop, including the name(s) of the perpetrator(s), victim(s), what happened and whether it was reported to the police. A 'Zero Tolerance' poster is included to display in the shop. 

F79) Record of Banned Customers

For recording the names, addresses and descriptions of any persons who have been banned from the pharmacy. 

F80) Complaints Timeline - Internal (a), Disciplinary Record (b) & Performance Improvement Plan - PIP (c)

For recording the events leading up to an internal complaint, the procedures required for disciplining the employee and a creating a plan for the employee for improving performance.

F81) Oral Contraceptives Tier 1 - Info for GP

For recording consultation results of patients presenting at the pharmacy with NHS prescriptions for oral contraceptives. Data collection form to send to the GP.

F82) Oral Contraceptives Tier 1 - Info for Manage Your Service (MYS)

For recording consultation results of patients presenting at the pharmacy with NHS prescriptions for oral contraceptives. Data collection form for uploading onto the MYS portal.

F83) Oral Contraceptives Tier 1 - Info for Integrated Care Board (ICB)

For recording consultation results of patients presenting at the pharmacy with NHS prescriptions for oral contraceptives. Data collection form for the ICB.

F84) CPPE Training 1 - Emergency Contraception

For recording staff members who have been trained on the 'CPPE Emergency Contraception' e-learning and date of training. 

F85) CPPE Training 2 - Contraception

For recording staff members who have been trained on the 'CPPE Contraception' e-learning and the date of training. 

F86) FSRH - Sexual & Reproductive e-learning

For recording staff members who have been trained on the 'FSRH Sexual and Reproductive' e-learning and the date of training. 

F87) CPPE Training 3 - Consultation Skills for Pharmacy

For recording staff members who have been trained on the 'CPPE Consultation Skills for Pharmacy Practice: Taking a Person Centred Approach' e-learning and the date of training. 

F88) CPPE Training 4 - Sexual Health in Pharmacies

For recording staff members who have been trained on the 'CPPE Sexual Health in Pharmacies' e-learning and the date of training. 

F89) FSRH - STIs of the FSRH e-learning

For recording staff members who have been trained on the 'STIs of the FSRH (module 9)' e-learning and the date of training. 

F90) CPPE Training 5 - Contraceptive Counselling

For recording staff members who have been trained on the 'CPPE Contraceptive Counselling' e-learning and the date of training. 

F91) Patients Offered NMS & Technique Check with New Inhaler

For recording the details of patients being offered an NMS when presenting to the pharmacy with a prescription for a new inhaler, to monitor the safe and correct use of inhalers. 

F92) Verbal Conversations Regarding Safe Inhaler Disposal

For recording the verbal conversations had with patients about the safe disposal of unwanted or unused inhalers. To be used in conjunction with F96 (Safe Disposal of Inhalers Leaflet). 

F93) Use of a Spacer Inhaler Patients Aged 5 to 15

For recording details of asthma patients aged 5 to 15, if they have been using a spacer device with their inhaler and whether or not they need to be referred back to their GP or prescriber. 

F94) Patients with a Personalised Asthma Action Plan (PAAP)

For checking if patients over the age of 5 have been provided with a PAAP and referring them to their GP, prescriber or relevant health professional if they have not. 

F95) Patients Using 3 or More SABA Inhalers in 6 Months

For checking if patients using 3 or more Short-Acting Bronchodilator Inhalers have a Corticosteroid Inhaler and if not, referring them to their GP, prescriber or relevant health professional. 

F96) Safe Disposal of Inhalers Leaflet

Leaflet for handing out to patients explaining the environmental and safety reasons for returning any used or unwanted inhalers to the pharmacy. 

F97) Persons Eligible for Flu Vaccinations

For maintaining a list of patients eligible for flu vaccinations, with examples included (over 50s, at risk groups, etc)

F98) Flu Vaccination Record Form

For recording patient details when administering the flu vaccine, including patient and GP details, the type of vaccine, adverse effects and any advice given. 

F99) Appliance Use Review (AUR) Record Form

For recording patient details and any advice given or referrals made during an Appliance Use Review. 

F100) Stoma Appliance Customisation (SAC) Record Form

For recording patient details, product information and any advice given or referrals made during a Stoma Appliance Customisation. 

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