Shared Care: Listed Alphabetically
Statement for Requests for Shared Care Agreements for Historic Patients
User guides for responding to Shared care Agreements for LPT Only :
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.
Acarizax Shared Care Agreement Request form
ADHD (adults) New Request Form National Format
ADHD (paediatric) New Request Form National Format
Agomelatine New Request Form National Format
Amiloride (paediatric cardiology)
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
Captopril (paediatric cardiology)
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
Enalapril (paediatric cardiology)
Furosemide (paediatric cardiology)
Guanfacine (adult) New Request Form National Format
Leflunomide New Request form National Format
Lisdexamfetamine (adults) New Request Form National Format
Lisinopril (paediatric cardiology)
Lithium Request form New Request Form National Format
Losartan (paediatric cardiology)
Mercaptopurine (paediatric gastroenterology)
Mercaptopurine (adult gastroenterology)
Methotrexate oral (rheumatology) New Request Form National Format
Methotrexate oral (dermatology) New Request Form National Format
Methotrexate oral (Adult Gastroenterology) 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)
Penicillamine (rheumatology) New Request Form National Format
Spironolactone (paediatric cardiology)
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