GP-CPCS Non-Urgent Escalation Form


Please call the bypass number if you require a response within less than 4 working hours.

This form should only be completed by pharmacy staff on behalf of patients registered at The Alexandra Practice.

GP-CPCS Non-Urgent Escalation

Section

About the escalation

Brief description as to why the patient is being escalated back to the practice
Brief description of the consultation undertaken by pharmacy
When does the patient require a response? (Please make sure patient is aware of this) *
Terms and Conditions *