Formulary

Prescribing Concern Form

The form should be used:

• If you wish to report any concerns regarding a specialist prescriber requesting that prescribing of a medication is transferred to primary care.

New product and new indication proposal form

The form could be used to apply for:

• Introduction of a new product to PTHB formulary 

• Urgent clinical need for a single patient

Formulary Amendment Form

The form could be used to apply for:

• The addition of a product or group of products where there is a minor change. Examples may be a new strength, change in formulation or device.
• Change to formulary status e.g. change to ‘Traffic Light’ classification for products.
• ‘Products’ includes medicines, prescribable appliances and medical devices.

Request to use an Unlicensed medicine : Appendix A

PTHB/ MMP 426 : Unlicensed and Off-label Medicines Policy for use in Powys Teaching Health Board community hospitals