List of forms from 01 to 30

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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.

 

If you only want a couple of forms you can choose from those  below. They cost £12.09+vat each and delivery is exclusively by email.

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.

 

Buy your Forms now and don't forget, if you feel that they have not saved you time and money, just send them back for a full refund but please tell us why because we want to make sure we are always providing the gold standard of what our clients want.

 

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