16. NHS Trusts/Organisations will have a named non-medical prescribing lead. If your organisation does not have a non-medical prescribing lead please complete the Clinical Placement Audit Form which can be found here: The course leader may contact your manager. Non-Medical Prescribing Lead: Name, employer and address. e-mail address: Telephone number: I support this application for training as a non - medical prescriber and approve the nominated DMP. Non-medical prescribing lead signature: Date: 17. Criminal conviction check: Applicants for the course should be aware that your employer will be asked to confirm that you have had a criminal convictions check. (Courses in health are exempt from the Rehabilitation of Offenders Act 1974). Independent practitioners must supply a recent Disclosure and Barring Service enhanced disclosure document. The Faculty of Health Studies may be able to facilitate independent practitioners’ application for a disclosure document. If you have been convicted of a relevant criminal offence since the last check you must tell us. Applicant self-declaration (please tick): I do not have any criminal convictions/cautions/bind –overs I have not had a criminal conviction since my last criminal conviction check I have a criminal conviction 18. Please attach a Curriculum Vitae (and provide a supporting statement below) with this application form that covers the following areas: - Name, job title, place of work, professional qualifications, academic qualifications including level, dates, work experience, study interests and professional activities, continuous professional development arrangements and how this course will help you develop prescribing practice?
16. NHS Trusts/Organisations will have a named non-medical prescribing lead. If your organisation does not have a non-medical prescribing lead please complete the Clinical Placement Audit Form which can be found here: The course leader may contact your manager. Non-Medical Prescribing Lead: Name, employer and address. e-mail address: Telephone number: I support this application for training as a non - medical prescriber and approve the nominated DMP. Non-medical prescribing lead signature: Date: 17. Criminal conviction check: Applicants for the course should be aware that your employer will be asked to confirm that you have had a criminal convictions check. (Courses in health are exempt from the Rehabilitation of Offenders Act 1974). Independent practitioners must supply a recent Disclosure and Barring Service enhanced disclosure document. The Faculty of Health Studies may be able to facilitate independent practitioners’ application for a disclosure document. If you have been convicted of a relevant criminal offence since the last check you must tell us. Applicant self-declaration (please tick): I do not have any criminal convictions/cautions/bind –overs I have not had a criminal conviction since my last criminal conviction check I have a criminal conviction 18. Please attach a Curriculum Vitae (and provide a supporting statement below) with this application form that covers the following areas: - Name, job title, place of work, professional qualifications, academic qualifications including level, dates, work experience, study interests and professional activities, continuous professional development arrangements and how this course will help you develop prescribing practice?
Prescribing-Application-Form-2019-20-Entry.docx