PGD approval/ development Name Job title and organisation John P Hampson Public Health Specialist, Cheshire West and Chester Council Dr Nicola Mullin Consultant in Sexual and Reproductive Health, Fountains Health, Chester David Sanchez Community Pharmacist, Liverpool Members of the PGD Jayne Fortune Health Improvement Practitioner Advanced, approval/development Cheshire West and Chester Council group Woolgar Health Improvement Specialist, Warrington Borough Council Cheryl Yeardsley Project Officer, Champs Collaborative Support Team Adam Major Commissioning and Mobilisation Manager, Champs Collaborative Support Team PGD authorisation Name Job title and Signature Date organisation Senior John. P Public Health Specialist, Pharmacist & Hampson Cheshire West and 22/04/2016 Lead Author Chester Council GPhC No= 2025614 Senior doctor Consultant in Sexual and Dr Nicola Mullin Reproductive Health, 22/04/2016 GMC No = Fountains Health, Chester 3547144 Representative Sanchez Community Pharmacist, of profession Liverpool 26/04/2016 GPhC No= 2045057 using PGD Person signing Eileen O’Meara Director of Public Health, 30/06/16 on behalf of Halton Borough Council authorising body Community Pharmacist agreement to practise under the Ulipristal Acetate 30mg tablets Patient Group Direction for Community Pharmacists I have read and understood the Patient Group Direction and agree to supply and/or administer this medicine only in accordance with this PGD Name GPhC Number Signature Date
PGD approval/ development Name Job title and organisation Members of the PGD approval/development group John P Hampson Public Health Specialist, Cheshire West and Chester Council Dr Nicola Mullin Consultant in Sexual and Reproductive Health, Fountains Health, Chester David Sanchez Community Pharmacist, Liverpool Jayne Fortune Health Improvement Practitioner Advanced, Cheshire West and Chester Council Woolgar Health Improvement Specialist, Warrington Borough Council Cheryl Yeardsley Project Officer, Champs Collaborative Support Team Adam Major Commissioning and Mobilisation Manager, Champs Collaborative Support Team PGD authorisation Name Job title and organisation Signature Date Senior Pharmacist & Lead Author John. P Hampson GPhC No= 2025614 Public Health Specialist, Cheshire West and Chester Council 22/04/2016 Senior doctor Dr Nicola Mullin GMC No = 3547144 Consultant in Sexual and Reproductive Health, Fountains Health, Chester 22/04/2016 Representative of profession using PGD Sanchez GPhC No= 2045057 Community Pharmacist, Liverpool 26/04/2016 Person signing on behalf of authorising body Eileen O’Meara Director of Public Health, Halton Borough Council 30/06/16 Community Pharmacist agreement to practise under the Ulipristal Acetate 30mg tablets Patient Group Direction for Community Pharmacists I have read and understood the Patient Group Direction and agree to supply and/or administer this medicine only in accordance with this PGD Name GPhC Number Signature Date
New-Signed-Ulipristal-PGD-2016-FINAL-15-April-2016-.docx