Name of Prescriber: See Attached Spreadsheet
Proposed Date of Transfer: See Attached Spreadsheet
Please download the SOP FORM PV01F48 V04 - Excel document_VT_Final - Protected.xlsx and enter the bulk patient information. Fields required are Patient Name, DOB, Gender, CPMS/ZTAS Number, Current Monitoring Frequency, Consultant Psychiatrist / Neurologist (Full Name), Pharmacy Site (Full Address), Collection Centre / Ward (Full Address), Diagnosis? TRS, Parkinsons or Other (if other please state), BEN (Benign Ethnic Neutropenia)? Y/N, Proposed Date of Transfer,Blood Barcodes to be sent to? (Collection centre or Pharmacy). Once the spreadsheet has been completed please browse to the spreadsheet using the browse button and upload the spreadsheet to complete the form and electronically sign.