Shared Care: Listed Alphabetically
Statement for Requests for Shared Care Agreements for Historic Patients
SCA’s are currently listed alphabetically by drug name (or disease). Where a drug doesn’t have it’s own specific request form please use this one Shared Care Request Form. This generic shared care request form is based on the national SCA forms and will be in use from the 3rd January 2023.
A programme of review of these shared care agreement documents is currently being undertaken. These are the current shared care agreements. If there are any concerns please contact [email protected]. Please do not send patient identifiable information as email may be unsecure.
New Request Form National Format
ADHD (paediatric) New Request Form National Format
Agomelatine New Request Form National Format
Allergen Specific Sublingual Immunotherapy (Acarizax, Grazax and Itulazax) in adults Request form
Allergen Specific Sublingual Immunotherapy (Acarizax And Grazax ) in Paediatrics
Atomoxetine (adults) New Request Form National Format
Azathioprine (dermatology) New Request Form National Format
Azathioprine (adult gastroenterology)
Azathioprine (paediatric gastroenterology)
Azathioprine neurology New Request Form National Format
Azathioprine (rheumatology) New Request Forms National Format
Ciclosporin (dermatology) New Request Forms National Format
Colistin (Historical Cystic Fibrosis Patients Only)
Denosumab (Prolia) for osteoporosis New Request Forms National Format
Denosumab (Xgeva) for prevention of skeletal events with bone metastases
Dexamfetamine (adults) New Request Form National Format
Guanfacine (adult) New Request Form National Format
Leflunomide New Request form National Format
Lisdexamfetamine (adults) New Request Form National Format
Lithium Request form New Request Form National Format
Mercaptopurine (paediatric gastroenterology)
Mercaptopurine (adult gastroenterology)
Methotrexate oral (rheum/Derm/Gastro) New Request Form National Format
Methylphenidate (adults) New Request Form National Format
Mycophenolate Mofetil Autoimmune conditions
Mycophenolate Mofetil Request form Dermatology New Request Form National Format
Mycophenolate Mofetil Request form Neurology New Request Form National Format
Mycophenolate Mofetil Request form Respiratory New Request Form National Format
Mycophenolate (renal transplant)
Paediatric Cardiology Medications
Penicillamine (rheumatology) New Request Form National Format
Sulfasalazine oral (rheumatology) New Request Form National Format
Sulfasalazine oral and rectal (gastroenterology)
Tacrolimus for Historic Renal Transplant Patients
Venlafaxine (high dose) New Request Form National Format