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Buccal Midazolam PGD Authorisation

BrisDoc Governance Team

Appendix A – Registered health professional authorisation sheet

PGD Name/Version: Salbutamol V1.1 Valid from: 15.12.2022 Expiry: 15.12.25  

 

Before signing this PGD, check that the document has had the necessary authorisations. Without these, this PGD is not lawfully valid.

 

Registered health professional

By signing this patient group direction, you are indicating that you agree to its contents and that you will work within it.

Patient group directions do not remove inherent professional obligations or accountability. It is the responsibility of each professional to practise only within the bounds of their own competence and professional code of conduct.

I confirm that I have read and understood the content of this Patient Group Direction and that I am willing and competent to work to it within my professional code of conduct.
Name Designation Signature Date
 

 

     
 

 

     
 

 

     
 

 

     
 

 

     
 

 

     
 

 

     

 

Authorising manager

I confirm that the registered health professionals named above have declared themselves suitably trained and competent to work under this PGD. I give authorisation on behalf of BrisDoc Healthcare Services for the above named health care professionals who have signed the PGD to work under it.
Name Designation Signature Date
 

 

 

 

 

 

 

 

Note to authorising manager

Score through unused rows in the list of registered health professionals to prevent additions post managerial authorisation.

This authorisation sheet should be retained to serve as a record of those registered health professionals authorised to work under this PGD. Practice and application must be compliant with the medicines management policy.

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