Library Services Ad Hoc Request Form

Contact Details
Requester Name: / Date:
Department / Practice: / Designation:
Phone Number: / E-Mail Address:
Title of Request
Description of Request
Anticipated Impact on Policy or Practice
Fit with Organisational Priorities
Corporate Objectives
See
Patient Safety
Health Improvement and Inequalities
Performance and Delivery
Processes and Structures
Local Delivery Plan
See
1: The Quality Ambitions and the wider outcomes-based approach
2: NHS Borders’ Contribution to the Borders Single Outcome Agreement
3: Health Improvement for the People of Scotland
4: Efficiency and Governance
5: Access to Services
6: Treatment Appropriate to Patient
Fit with Organisational Priorities (contd)
HEAT Targets
See
Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy
Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS
Access to Services – recognising patients’ need for quicker and easier use of NHS services
Treatment Appropriate to Individuals
Other / Personal
Please specify:
Requested Timelines
Requested Start Date: / Requested Completion Date:
Signed (requester):
Date:
FOR LIBRARY USE ONLY
Library User Group:
Doctors
□ BGH
□ F1 / F2 / ST – BGH
□ General Practitioner
□ Doctor - Mental Health
□ Doctor - Learning Disabilities
□ Doctor - Public Health
□ Medical Student
AHPs
□ BGH
□ Primary Care
□ Student
Other
□ Other (Labs, Pharmacy, Physiological measurement, etc) BGH
□ Psychological services
□ Dental
□ Social Work
□ BordersCollege – Healthcare student
□ BordersCollege - Staff / Nurses, midwives & HCSWs
□ Nurse - BGH
□ Nurse - CommunityHospital
□ Nurse - Public Health
□ Nurse - Community
□ Nurse - Practice
□ Nurse - Mental Health
□ Nurse - Learning Disabilities
□ Nurse Bank
□ Nursing Student – Edinburgh Napier
□ Nursing Student - QMU
□ Midwife
□ Midwifery Student
□ Health Care Support Worker – BGH
□ Health Care Support Worker - LD
□ Health Care Support Worker – PC
□ Health Care Support Worker- MH
Admin, clerical & support
□ BGH
□ Primary Care
□ Mental Health
□ Learning Disabilities
□ Support Services
Outcome: / Accepted
Declined
More information requested
If declined or more information requested, please specify reasons:
Date of Review Meeting:
Feedback from user:
Important: please confirm if anticipated impact was realised
Approximate time taken (hours):
Work completed by:
Signed:
Date Completed:

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Library Services ad hoc form V1.doc13/09/2018