Patient Templates (Diary Forms)

Toniq templates are useful whenever a form is required, not just for LTC Service requirements. Fields pre-populate with available information, can be stored in patients' history, and are helpful for audit or clinical reviews.

Using patient diary templates

• Select a patient, press F10 Other and Open patient diary.
• Press F7 Use Tmplate and select the one required.

Create your own template

Simple templates can be made by going to:

• 9. Other
• 5. Edit note templates
• Press F3 Add
• Use the options under F3 Patient field and F4 Other field to  add pre-population details such as patient name, NHI, and date
•  use the function keys to format the document

More detailed forms can created in Word and then imported into Toniq:

• Create a Word document of the form you want to import
  • Tip: use tables to format where the fields need to be
• Save as a .rtf:
  • In Word, press Save as
  • Select Rich Text Format from the drop-down box below the file name:

• • Tip: Save the attachment to C:\Toniq Users\Notes\Templates - use the [Backspace] key to aid in navigating in the file browser - so that loading it is easier
• Then in Dispensary, load the saved template into Toniq Dispensary:
  • From the Main Menu, go to 9. Other > 5. Edit note templates
  • Press F3 Add, then press F10 Other and select 4 Load from template file (.WPT)
  • Highlight the required template
  • Press F12 Accept Details to save that template

•  

Importing templates provided by Toniq

Some templates are available upon request from Toniq for regional or targeted uses. Please email [e-mail] to enquire if a template for a specific group is available and to request it.

If a form is not available, we may be able to convert it into a Diary Template. Send Word or PDF documents in preference, otherwise a scan of the form, to [e-mail].

Available Templates

Toniq is continually adding to and revising the library of templates available for initiatives and medicine and service consultations.

General/Med Templates	Description and Usage
TQ Emergency Contraception	Check list to print for patient to fill in, and take away. Store in patient history
TQ TMP UTI Assessment	College of pharmacist's patient check list to be filled in when trimethoprim supplied by pharmacist. Store in patient history – notify GP
TQ Emergency Supply	Declaration of pharmacy supply. Store in patient history. Print and file for Audit
TQ Quitline Referral Form	Simple form with patient details to fax to Quitline
TQ Silvasta/Vedafile/Sildenafil Form 1 Screening	Screening for each of the 3 brands to determine if pharmacy supply or patient GP referral indicated
TQ Silvasta/Vedafile/Sildenafil Form 2 Supply	Template for each of the 3 brands with patient details and guidelines for supply. Store in patient history
TQ Form for WINZ funding	To fund packing costs for a particular patient. Statement of patient factors and costs. Print and process Store in patient history
TQ Incident Reporting – PDA	3 Page PDA based form for reporting details of an incident. Store in patient history, print, process and file
TQ Carm Form for Adverse Reactions	Adverse Reactions to Medicine, Vaccines and Devices and all clinical events for IMMP. To be faxed or posted
TQ Section 29 Form	Medsafe Declaration/Notification Form for medicines supplied pursuant to Section 29 of Medicines Act 1981
TQ CDHB Stop smoking	Referral form for stop smoking service ie: Te Ha Waitaha
TQ Gout forms	Gout prevention programme
TQ Yellow Card Landscape	Each DHB uses its own wording on their yellow card but Toniq has provided a variant as template. Edit to your DHB requirements and print to yellow paper, then print a Medicine Chart onto the other side.

CPAMS Templates	Description and Usage
TQ CPAM Consent Form	Print for patient to fill in. Store in patient history and file in pharmacy
TQ CPAM Invoice	Form can be used to invoice CPAM services

LTC Templates	Description and Usage
LTC1 to LTC8	Required templates for delivery of the LTC service. Include Evaluation, Registration/Consent, Medicines Management, Annual Re-assessment. Exit & Transfer
LTC8 Transfer Request	Request from one pharmacy to another to exit the service so the patient can be re-registered at another pharmacy
TQ Doctor LTC Info Request	Request from pharmacy to prescriber for patient long term conditions and hospital admissions
LTC Leaflet	Print for patient information. Facilitates self-evaluation and details service for patient. Store in patient history
LTC Mental Health Diagnosis	Flowchart to help with evaluation of mental health condition. To decide if condition scores 10 points or 2
TQ Heart Failure	Checklist for LTC patients with Heart Failure

Special Prescription Plan
TQ Abbvie Care Pharmacy Programme	Patient counselling monthly checklist
TQ Maviret QUM	Quality use of medicines guide - Abbvie