The documents below contain standard forms for communicating information to Prescribing Services for non-medical prescribers.
Each form is published in two formats:
LOCUM IP Prescription Pad Requests
To order an IP Locum prescription pad for your pharmacy can the superintendent pharmacist / pharmacy owner please email using the following address:
nwssp-primarycareservices@wales.nhs.uk marking the email 'FAO Pharmacy Contracts Team'. Please be aware that the pharmacy needs to be accredited on the AWPD and have a pharmacist already registered.
All Other IP Requests
Please submit your completed form to:
email: Prescribing.Management@Wales.nhs.uk
Nurse Prescriber Annex A1 (PDF,8.94kkb)
Nurse Prescriber Annex A1 (doc,4.75kb)
Nurse Prescriber Annex A2 (PDF,9kb)
Nurse Prescriber Annex A2 (doc,46.5kb)
Independent Prescriber Notification Form (PDF,128kb)
Independent Prescriber Notification Form (doc,92kb)
Independent Prescriber Notification WAST (Welsh Ambulance Service NHS Trust) (PDF,118kb)
Independent Prescriber Notification WAST (Welsh Ambulance Service NHS Trust) (doc,80kb)
Optometrist Independent Prescriber Notification Form (PDF,117kb)
Optometrist Independent Prescriber Notification Form (doc,58kb)
Pharmacy Independent Prescriber Notification Form (PDF,129kb)
Pharmacy Independent Prescriber Notification Form (doc,65.5kb)
Supplementary Prescriber Notification Form (PDF,134kb)
Supplementary Prescriber Notification Form (doc,91kb)