Product Information (list all products on the wound) List formulary Reason formulary Would you like this New product Rationale for non- Would you like this product product products not product to be used/product formulary product to be considered for suitable considered for choice inclusion? deletion? Patient ID Number:……………………………………………….. Completed by:……………………………………………………… Practice:……………………………………………………………. Date…………………………………………………………………...
Product Information (list all products on the wound) List formulary product Reason formulary products not suitable Would you like this product to be considered for deletion? New product used/product choice Rationale for non- formulary product Would you like this product to be considered for inclusion? Patient ID Number:……………………………………………….. Completed by:……………………………………………………… Practice:……………………………………………………………. Date…………………………………………………………………...