Thrush Consultation

Patient Name

First

Last

Patient Consent

obtained from the patient/carer who does not want to consult with their GP and would prefer to access treatment from the PGD user

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Inclusion Checklist for supply of miconazole or clotrimazole containing products for candidal SKIN infections.

Patients 18 years and over presenting with an uncomplicated candidal skin infection.
Valid consent has been gained from a patient/guardian who does not want to specifically consult with a doctor and who is happy for the supply to be given by the PGD user

Tick the one that applies

Patient is INcluded in supply of miconazole or clotrimazole containing products for candidal SKIN infections.
Patient is EXcluded from supply of miconazole or clotrimazole containing products for candidal SKIN infections.

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Tick the one that applies

Patient is INcluded in supply of clotrimazole containing products for GENITAL thrush
Patient is EXcluded from supply of clotrimazole containing products for GENITAL thrush

Type of consultation

Check patient ID presented e,g passport, Drivers License or Photocard

If other, please specify

See PGD for caution related to supply of SKIN or GENITAL infection as required

See PGD for product interactions related to supply of SKIN or GENITAL infection as required

Action if patient is excluded from the service

Discuss with patient and document the reasons for exclusion from treatment under the PGD.
If the patient has consented, refer them to their GP and/or inform their GP.
Signpost to other services if appropriate.
Document the reasons for exclusion and any action taken, in the patient’s medication record.
When treatment is postponed reschedule as appropriate

Action if patient declines the service

Ensure patient/carer fully understands the risks of declining the service
Advise the patient/carer about the benefits of the service
Refer patient to GP if appropriate.
Document the reasons for declining the service and any action taken, including advice given to the patient.
Document the reasons for declining the service and any action taken, including advice given to the patient.
Explain NHS eligibility for this service where appropriate
Advise patients of the risk factors for developing infection.

Document reason for exclusion, patient decline or any advice given or action taken in patient’s clinical records

Additional information that may be relevant (e.g. patient temperature)

Healthcare Professional Name

First

Last

GPHC Number

Date

Start Assessment