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.
Triage document utilised by Metastatic Spinal Cord Compression (MSCC) coordinators.
Liver Cirrhosis Clinic
e-form for recording patient care and observations within the Liver Cirrhosis Clinic.
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.
e-form for recording side-effects a patient is experiencing with Oncology treatment cycles.
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.
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 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.
Triage e-form for recording details of emergency patient admissions to the Coronary Care Unit (CCU).
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.
Endoscopy Opinion Request to Cardiorespiratory
Opinion request form allowing Endoscopy clinicians to request advice from the Cardiorespiratory specialty.
e-form for operations across multiple specialties. Uses signature pad to capture patient's signature.
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.
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.
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.
Set of five referral e-forms for referral from optometrists into secondary care:
Radiological investigation request e-form. Completed form is sent to the preferred site of radiological investigation.
Request for PICC insertion
Referral letter requesting Peripherally Inserted Central Catheter (PICC) insertion for a patient and recording of subsequent procedure.