ADHD Screening Form

From 01 July 2024, we will no longer be able to take on prescribing and monitoring of shared-care medication or specialist monitoring for ADHD for new patients with a diagnosis made in the private sector (please click here for more information)

If you have had a diagnosis of ADHD, made by the NHS, then please make a prescription request via this form which will be screened by a GP. The GP will review your form and clinical notes, and then follow the NHS Lothian Shared Care Protocol (please click here for more information) for ADHD specialist medication to assess the suitability of your request. You may get a call from our receptionist if there is a need for further discussion.

For adults (aged 18+), we will only issue ongoing prescriptions after handover from the specialist when the dose is stable and you provide the following:

Blood pressure, weight and heart rate every six months
Have an annual review with an ADHD specialist

For children (under 18), all monitoring will be carried out by your specialist at the recommended time intervals.

All monitoring continues to be carried out by your specialist at the recommended time intervals.

We will not be able to continue to prescribe if you do not attend for this monitoring or annual review.

PERSONAL AND PRESCRIPTION DETAILS

What is your name? *

What is your date of birth? *

What is your mobile telephone number? *

Please type in the ADHD medication you are requesting *

Please type in which chemist you want the prescription to be sent to, or indicate if you want to collect it from the surgery. *

NHS LOTHIAN SHARED CARE PROTOCOL

Morningside Medical Practice will only continue ADHD if a patient has been stabilised on medication and it follows the NHS Lothian Shared Care Protocol. Please click here for more information.

Morningside Medical Practice will not change the dosage or regime of ADHD medications – this can only be done by an ADHD specialist who will organise the prescription and any necessary follow-up.

If a patient wishes to change their regime of medication, then we would recommend that they speak with their ADHD specialist.

I HAVE READ AND UNDERSTAND THE NHS LOTHIAN SHARED CARE PROTOCOL INFORMATION GIVEN ABOVE. (If you tick no and/or do not understand this information, then you will get a call from our receptionist to make a clinician appointment.) *

Yes No

I WISH TO HAVE A DISCUSSION ABOUT MY ADHD MEDICATION WITH A CLINICIAN FURTHER. (If you tick yes, then you will get a call from our receptionist to make a clinician appointment.) *

Yes No

I wish to continue my adhd medication. (if you tick no, then you will get a call from our receptionist to make a clinician appointment) *

Yes No

CLINICAL INFORMATION

If you have read, understand, and are happy to continue with your ADHD medication and you do not wish to discuss it further, the clinician will look at the answers you provide to the clinical information below.

The clinician may contact you to clarify information, but if the clinician is happy with your answers they will issue and send the prescription for you on the date that the receptionist organised the clinician screening review for you to the chemist that you have indicated above.

If you have asked for a further clinician discussion, or the clinician wants a further discussion, the receptionist will call you for an appointment.

Please answer the following clinical questions to aid the review:

BMI: Click here to help you calculate your BMI.

Please type in your average BP reading and when it was taken. (You can get this checked at home, in the high street chemist, or make a nurse BP appointment.) *

PLEASE TYPE IN YOUR HEART RATE (PULSE) AND WHEN IT WAS TAKEN. (YOU CAN GET THIS CHECKED AT HOME, IN THE HIGH STREET CHEMIST, OR MAKE A NURSE BP APPOINTMENT.) *

Please type in your height (cm), weight (kg), BMI (see above link to help you calculate this), and when it was taken. (You can get this checked at home, in the high street chemist, or make a nurse BP appointment.) *

DATA PROTECTION AND CONSENT

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

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Page last reviewed: 28 June 2024
Page created: 16 August 2023

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ADHD Screening Form

ADHD Screening Form

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