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Non-Medical Prescribers

non prescriber filling out form

The documents below contain standard forms for communicating information to Prescribing Services for non-medical prescribers.

Each form is published in two formats:

  • MS Word documents for electronic completion
  • PDF documents for general printing

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

 


Key Document


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Nurse Prescriber Annex A1 & A2


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 Nurse Prescriber Annex A1 (PDF,8.94kkb)

 

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Nurse Prescriber Annex A1 (doc,4.75kb)

 

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Nurse Prescriber Annex A2 (PDF,9kb)

 

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Nurse Prescriber Annex A2 (doc,46.5kb)

 

Independent Prescriber Notification Form


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Independent Prescriber Notification Form (PDF,128kb)

 

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Independent Prescriber Notification Form (doc,92kb)

 

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Independent Prescriber Notification WAST (Welsh Ambulance Service NHS Trust) (PDF,118kb)

 

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Independent Prescriber Notification WAST (Welsh Ambulance Service NHS Trust) (doc,80kb)

 

Optometrist Independent Prescriber Notification Form


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Optometrist Independent Prescriber Notification Form (PDF,117kb)

 

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Optometrist Independent Prescriber Notification Form (doc,58kb)

 

Pharmacy Independent Prescriber Notification Form


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Pharmacy Independent Prescriber Notification Form (PDF,129kb)

 

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Pharmacy Independent Prescriber Notification Form (doc,65.5kb)

 

Supplementary Prescriber Notification Form


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Supplementary Prescriber Notification Form (PDF,134kb)

 

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Supplementary Prescriber Notification Form (doc,91kb)