HLP Champion Training Booking Form

Please complete the following survey to apply for a HLP champion training course.

PLEASE NOTE : THE HLP CHAMPION MUST BE A FULL TIME EQUIVALENT MEMBER OF STAFF OR THE PHARMACY TEAM

IF YOU HAVE PART TIME STAFF - YOU MAY NEED TO TRAIN MORE THAN ONE MEMBER OF STAFF TO MEET THE REQUIREMENT. THE LLRLPC CAN FUND ONE PLACE SO YOU WILL NEED TO SELF FUND ANY  ADDITIONAL TRAINEES .

The course will take approximately 8 hours distance learning and an in pharmacy assessment will be conducted supervised by the Pharmacist in store.

if you complete this form - you will be expected to complete this course in 8 weeks from the date of receiving the course.

We are being supported financially  By Health Education England therefore we must ensure the training is completed as soon as possible

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* 1. Pharmacy Name

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* 2. Pharmacy Address and postcode ( please complete this field fully)

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* 3. Telephone number

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* 4. Name of HLP champion to undertake Training Course - please ensure this a pharmacy member of staff and should meet the equivalent of one full time member of staff in your team. you may need to self fund other pharmacy staff to undertake the course to meet the national requirement.

please note LPS contracts are not eligible to claim  quality payments.

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* 5. email address of HLP champion

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* 6. Name of Supervising Pharmacist ( ideally the HLP lead)

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* 7. GPhC number of Supervising Pharmacist

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* 8. Email address of Supervising Pharmacist

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* 9. Do you need to self fund additional hlp champions in your pharmacy ?

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* 10. Do you prefer an elearning or paper based course

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* 11. i confirm that the HLP champion training course will be  completed within 8 weeks of receiving the course

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