Emergency Supply of Medications : Triage Questionnaire

This triage tool includes all necessary checks and considerations for evaluating requests for emergency medication supplies. It ensures safe prescribing while adhering to UK prescribing practices and restrictions on controlled drugs.

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1. Patient Identification and Consent

☐ Full Name: _________________________________
☐ Date of Birth: ______________________________
☐ Address: ___________________________________

☐ Do you consent to us accessing your medical records to verify your medication history?

• ☐ Yes
• ☐ No

☐ Do you consent to us contacting your GP or regular pharmacy if necessary?

• ☐ Yes
• ☐ No

☐ Is your usual GP practice open now, or will they be open soon?

• ☐ Yes (contact your GP practice directly)
• ☐ No
• 
  

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2. Regular Prescription Status

☐ Is this medication on your regular repeat prescription?

• ☐ Yes
• ☐ No

☐ When did you last request a repeat prescription?

• Date: __________________

☐ Why were you unable to obtain your medication through normal channels?

• ☐ Forgot to order in time
• ☐ Prescription delayed by GP
• ☐ Misplaced medication
• ☐ Traveling or away from home
• ☐ Other (specify): ______________________
• 
  

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3. Medication Details

☐ What medication(s) do you need an emergency supply for?

• Name(s): _______________________________
• Dosage/strength: _________________________

☐ Is this a controlled drug (e.g., morphine, tramadol, diazepam)?

• ☐...