Registration Form
`Hospital Pharmacist Prescribers Conference
Delivering for Prescription for Excellence`
Wednesday 10th June 2015
(Please complete in full and ensure you submit both pages 1 and 2)
FULL NAME:GPhC No:
JOB TITLE:
PLEASE TICK WHICH CRITERIA YOU MEET FOR ATTENDANCE
Hospital pharmacist who is prescribing
Hospital pharmacist who is qualified as a prescriber
butis currently not using this qualification
Hospital pharmacist who iscurrently undertaking
the Independent Prescribing or Conversion course
Clinical Pharmacy Lead Pharmacist working in Secondary
Care with responsibility for implementing pharmacist prescribing
Services
Director of Pharmacy/Acute Lead
NHS Board:
Clinical Area of Prescribing Practice:
(please complete – detail is required for networking workshop- Session 2)
Contact telephone:
Email:
Please give details if you have any special needs or special requirements which may be relevant to this application.
______
Workshop Selection - Session 1
Please prioritise your choice of session(ie 1= 1st preference to 3 = 3rd preference)
We will try to meet your preferences as much as possible!
- Opportunities and challenges for Hospital
Pharmacists working in primary care as IPs
- Teach & Treat – How to develop
- What skills/support do practising hospital IPs
require to deliver on Prescription for Excellence
For further information please contact NES Pharmacy office
tel: 0141 352 1622 or email:
To register please complete and return this Registration Form to
OR Fax 0141 223 1603
Or send by post to:
Chantelle Burrow
NHS Education for Scotland (Pharmacy)
3rd Floor, 2 Central Quay
89 Hydepark Street
Glasgow , G3 8BW
DEADLINE: FRIDAY 8th May 2015
Protection: NES uses the personal data you provide for purposes associated with our responsibilities for health workforce development, including the administration of courses, monitoring training programmes and circulating information relating to relevant
Please note that photographs of the event may be taken for reproduction in NES publications/ website. This may involve flash photography. Please inform a member of the NES Events Team should you have any objections to being included in photographs. Data development opportunities. For more information see Personal data will be retained in line with our records retention policies. We will not share your data with third parties.