Dumfries & Galloway Health Board
Prescribing Support Team

ADTC Forms

This is a description of what ADTC forms are, which you can edit using the pencil icon at the end of this paragraph, which you'll only see if you're logged in.

Peer Approved Clinical System (PACS) Tier Two Request Form and Decision Record

This form is only to be used to request access to a licensed medicine that; is a medicine for an indication that has been considered and not recommended for use in NHS Scotland by the Scottish Medicines Consortium (SMC); or is a medicine accepted for restricted use by SMC but the intended use is out with SMC restrictions; or is a medicine which has been submitted and is awaiting/undergoing evaluation by the SMC.

9 Aug 18

PACS Tier 2 Policy

This policy outlines the NHS D&G management process for medicines requested via the Peer Approved Clinical System Tier 2 (PACS 2) which replaces the previous Individual Patient Treatment Request (IPTR) process. The exception is where the medicines is not approved due to a non submission. In these cases an IPTR form should be used).

9 Aug 18

Business case template

Application for the use of a new medicine, or new indication for an existing medicine (includes unlicensed/off label use).

23 Feb 17

Pay and Report Guidance

‘Pay and Report’ covers all products where it is not clear whether or not the product in question should be classified as a drug.

1 Aug 13

IPTR - data collection form

Data collection form to be submitted to ADTC (IPTR sub committee) through the Medical Director's office.

9 Jul 12

IPTR decision form

This data collection sheet captures all information considered regarding an individual patient treatment request for licensed medicines which have been assessed by SMC and NOT RECOMMENDED for use within NHS Scotland.

9 Jul 12

Individual Patient Treatment Requests (IPTRs) - A Framework

This document details the framework for handling IPTRs in NHS Dumfries & Galloway.

17 Apr 12

Individual Patient Treatment Request (IPTR) Evidence Briefing Template

This document contains advice on what information should be included in an Individual Patient Treatment Request.

17 Apr 12

A patient's guide to Individual Patient Treatment Requests (IPTRs)

This a guide for patients about Individual Patient Treatment Requests, the reasons for them and the process that they follow.

17 Apr 12