Get The Medscheck Consult Pilot Project Application ... - Ontario.ca - Health Gov On

This guide provides a comprehensive overview for users on how to complete the MedsCheck Consult Pilot Project Application. Following these steps will help ensure that all necessary information is submitted accurately and efficiently, facilitating participation in the program.

Follow the steps to complete the application form successfully.

1. Press the ‘Get Form’ button to access the application form and open it for editing.
2. Enter the pharmacy information, including the pharmacy name, accreditation number, address, telephone number, and email address. Ensure all fields are filled in accurately.
3. Indicate the affiliated Local Health Integration Network (LHIN) and Ontario College of Pharmacists (OCP) district by providing the required details.
4. Acknowledge whether the pharmacy manager or owner has been informed about the application by selecting 'Yes' or 'No'. If applicable, delegate another pharmacist as the contact person.
5. Check all types of pharmacy practice sites that apply, such as outpatient clinics or independent pharmacies.
6. If applicable, provide the name and address of the Family Health Team the pharmacy is affiliated with.
7. List the pharmacists participating in the pilot by filling in their names and OCP numbers in the designated fields.
8. Provide additional pharmacy and practice information, including the percentage of patients who are Ontario Drug Benefit (ODB) recipients, daily and weekly prescription volumes, pharmacy hours of operation, and pharmacist-to-technician ratios.
9. Detail any common therapy issues or drug-related problems that may arise at the practice site.
10. Indicate if you have an established professional relationship with physicians participating in the study and if you have contacted them about the pilot.
11. List the physicians you have contacted, providing their names, CPSO numbers, and telephone numbers as required.
12. Confirm your commitment to the pilot program by indicating your availability for active participation and follow-up communication.
13. Once all information is filled out, review the form for accuracy. You can then save changes, download the completed form, print it, or share it as needed.

Complete your application form online today to ensure your participation in the MedsCheck Consult Pilot Project.