Change of Medication
Change of Treatment
e-form that is sent to the patients' GP requesting a change of treatment for a patient following a hospital visit.
Clinical Notes
Anti-Microbial Authorisation
e-form detailing prescription of anti-microbial drugs.
Breast Care Nursing Admission
e-form detailing investigations and treatment plan for breast care.
Clinical Notes
Basic form used for recording clinical notes.
COVID-19 Triage
Checklist e-form for COVID-19 on patient admission.
Electronic Triage
Triage document utilised by Metastatic Spinal Cord Compression (MSCC) coordinators.
Inflammatory Bowel Disease (IBD) Helpline
Record of calls taken via IBD Helpline.
Intravesical Treatment
Patient Intravesical Treatment record.
Liver Cirrhosis Clinic
e-form for recording patient care and observations within the Liver Cirrhosis Clinic.
Lymphoedema Services
Lymphoedema services clinic record.
NHS Near Me Blood Request form
Request form for phlebotomy to take place at local care centres near the patient as opposed to requiring a main hospital visit.
Oncology Toxicity
e-form for recording side-effects a patient is experiencing with Oncology treatment cycles.
Pre-Op Assessment
e-form utilised in pre-operative assessment process.
Pre-Op Assessment
Large e-form detailing patient pre-op assessment. Includes summary form output detailing important highlights of the completed form in the patient record.
Record of Hospital Day Care
Record of a patient's day care. Records observations, vensection, therapeutic infusions, venflon, biologic therapies.
Resucitation Record
Record of patient resucitation.
Discharge Letter
Dental Paediatric GA Discharge
e-form detailing paediatric dental procedure carried out under general anaesthetic. Form is distributed to patient's dental practice.
Obstetric Anaesthesia
Obstetric anaesthesia record detailing operative delivery, epidural and any post-op symptoms.
PNW Neonatal Discharge
Discharge document detailing medical review and treatment of patient’s on the neonatal ward.
Emergency Recording
CCU Triage
Triage e-form for recording details of emergency patient admissions to the Coronary Care Unit (CCU).
Resucitation Record
Record of patient resucitation.
GP Letter
Dietetic Report
Form sent to GP detailing nutrition and diabetic management plan for a patient.
End of Treatment Summary
Treatment summary following completion of cancer treatment.
Minor Injury Unit
Record of attendance at Minor Injury Unit.
Verification of Death and Death Notification Form
e-form detailing checks to verify death, date and time of death and further details such as place of death and whether relatives have been informed. Utilised as initial notification to GP prior to completion of Medical Certification of Cause of Death (MCCD). Reporting also carried out on numbers of and data within this form.
MDT Record
Colorectal Multidisciplinary Team (MDT)
Colorectal MDT process e-form.
GI Complex Polyp MDT
Gastro-intestinal Complex Polyp MDT e-form.
Haematology MDT
Haematology MDT e-form.
Hepatocellular Carcinoma (HCC) MDT
HCC MDT e-form.
Hepatic Pancreato Biliary (HPB) MDT
HPB MDT e-form.
Inflammatory Bowel Disease (IBD) MDT
IBD MDT e-form.
Lung MDT
Lung MDT process e-form.
Other Gastro-intestinal (GI) MDT
Generic GI MDT e-form.
Pelvic Floor MDT
Pelvic floor MDT e-form.
Skin Cancer MDT
Skin cancer MDT process e-form.
Upper GI MDT
Upper GI MDT process e-form.
Urology MDT
Set of forms for use in urology MDT process.
Opinion Request
Endoscopy Opinion Request to Cardiorespiratory
Opinion request form allowing Endoscopy clinicians to request advice from the Cardiorespiratory specialty.
Patient Consent
Patient Consent
e-form for operations across multiple specialties. Uses signature pad to capture patient's signature.
SACT Consent
e-form for recording patient consent for Systemic Anti-Cancer Therapy (SACT). Patient and clinician signatures captured using a signature pad.
Patient / GP Letter
Ambulatory Emergency Care
Document detailing investigations and treatment carried out at ambulatory emergency care.
Pre-operative Diabetes Medication Recommendations
Instructions to a patient on changes to their diabetic medication schedule prior to surgery.
Referral Letter
Acute Pain Referral
Referral letter to acute pain team for patients suffering from chronic pain.
Community Team Referral Form
e-form detailing referral to community care team. Includes reason for referral, current service usage, accommodation details, PMH and current risks and abilities.
Dental Referral
Referral form completed by dentist in dental practice. Completed form routed through SCI Gateway into PMS and serves as a process for a dentist referring a patient into secondary care.
Occupational Health Referral
Staff referral to Occupational Health e-form detailing staff absence.
Ophthalmology Referral
Set of five referral e-forms for referral from optometrists into secondary care:
Ophthalmology Referral – Cataract
Ophthalmology Referral – General
Ophthalmology Referral – Glaucoma
Ophthalmology Referral – Paediatric
Ophthalmology Referral – Wet Age-related Macular Degeneration (AMD)
Radiology Request
Radiological investigation request e-form. Completed form is sent to the preferred site of radiological investigation.
Referral to Investigation and Treatment
Referral form for referring patient to third space care.
Request for PICC insertion
Referral letter requesting Peripherally Inserted Central Catheter (PICC) insertion for a patient and recording of subsequent procedure.
Tissue Viability Referral
Patient referral e-form to Tissue Viability Department.
