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Covid 19 Information

Please visit www.ghc.nhs.uk/coronavirus/

Non Formulatory Exception Reporting Form

 

Please complete this form to request use of a non-formulary product. Your information will help us monitor the appropriateness of the present formulary and aid future decision-making.

Non-Formulary Exception Reporting Form

Please complete this form to request use of a non-formulary product. Your information will help us monitor the appropriateness of the present formulary and aid future decision-making
  • Requestor details

  • Wound Details

  • Formulary Details

    Please tell us about any formulary products used to date, the duration of use and reason they were discontinued or not suitable. Please use a separate text box for each product.
  • Non Formulary Details

    Please tell us about the non-formulary product you propose to use

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