ONS Service Level Agreement N.Lincs

ONS Service Level Agreement - N.Lincs
Practice Details
Practice Name*
Clinical Lead for project and approval of pharmacist interventions*

Full NameNHS Email
Practice Manager for project*

Full NameNHS Email
Admin/IT lead for system access*

Full NameNHS Email
SystmOneEMIS
YesNo
Clinical Review
YesNo
YesNo
Please add any further comments in relation to the scope of service or Pharmacist activity in relation to optimising ONS therapy at your Practice
Pharmacist Actions & Authorisation

GP approval for Pharmacist to implement approved interventions and update patient record*

Rows	Authorisation (Y/N)
Change Compact (RTD) formula to cost-effective RTD of formulary choice - FOODLINK COMPLETE COMPACT
Change Energy (RTD) formula to cost-effective RTD of formulary choice - FOODLINK COMPLETE
Change Fibre (RTD) formula to cost-effective RTD of formulary choice - FOODLINK COMPLETE WITH FIBRE
Change Low Energy (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN ENERGY
Change Modules (RTD) to more cost-effective product - ALTRASHOT
Change Desserts (RTD) to more cost-effective product - NUTRICREM
Change Protein (RTD) formula to cost-effective RTD of formulary choice - FOODLINK COMPLETE
Change Juce (RTD) formula to cost-effective RTD of formulary choice - ALTRAJUCE
Stop ONS if appropriate - NO CLINICAL INDICATION
Change High Energy A (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN COMPACT DAILY
Change High Energy B (RTD) formula to cost-effective RTD of formulary choice - FOODLINK COMPLETE
Change High Energy C (RTD) formula to cost-effective RTD of formulary choice - FOODLINK COMPLETE COMPACT
Change High Energy Powder (RTD) formula to cost-effective RTD of formulary choice - FOODLINK EXTRA

I agree to the Clinical Pharmacist implementing therapy changes in accordance with the Nutritional Support review protocol and criteria listed above.
GP Name*

Full NameDate (DD/MM/YY)
Signature*

Clear
*Remote working will only be conducted after sharing a Data Processing Agreement

This service has been financially supported by Nualtra Ltd.
Should be Empty:

ONS Service Level Agreement - N.Lincs