Toniq templates are useful wherever a form is required, not just for LTC service requirements. Remember, they self-populate where possible and can be stored in patient history, helpful for audit and/or clinical review.
Toniq is continually adding to and revising the library of templates available for these initiatives and medicines. One of the latest, seasonally appropriate ones, is the new single-page Flu Kit Consent Form.
We are happy to look at your document and advise if we are able to convert it into a Diary Template. Word or PDF documents preferably, otherwise a scan of the form, can be sent to support@toniq.co.nz and we’ll let you know what we can do.
Available Templates
| General/Med Templates | Description and Usage |
| TQ Emergency Contraception | Check list to print for patient to fill in, and take away. Store in patient history |
| TQ TMP UTI Assessment | College of pharmacist's patient check list to be filled in when trimethoprim supplied by pharmacist. Store in patient history – notify GP |
| TQ Emergency Supply | Declaration of pharmacy supply. Store in patient history. Print and file for Audit |
| TQ Quitline Referral Form | Simple form with patient details to fax to Quitline |
| TQ Silvasta/Vedafile/Sildenafil Form 1 Screening | Screening for each of the 3 brands to determine if pharmacy supply or patient GP referral indicated |
| TQ Silvasta/Vedafile/Sildenafil Form 2 Supply | Template for each of the 3 brands with patient details and guidelines for supply. Store in patient history |
| TQ Form for WINZ funding | To fund packing costs for a particular patient. Statement of patient factors and costs. Print and process Store in patient history |
| TQ Incident Reporting – PDA | 3 Page PDA based form for reporting details of an incident. Store in patient history, print, process and file |
| TQ Carm Form for Adverse Reactions | Adverse Reactions to Medicine, Vaccines and Devices and all clinical events for IMMP. To be faxed or posted |
| TQ Section 29 Form | Medsafe Declaration/Notification Form for medicines supplied pursuant to Section 29 of Medicines Act 1981 |
| TQ CDHB Stop smoking | Referral form for stop smoking service ie: Te Ha Waitaha |
| TQ Gout forms | Gout prevention programme |
| TQ Yellow Card Landscape | Each DHB uses its own wording on their yellow card but Toniq has provided a variant as template. Edit to your DHB requirements and print to yellow paper, then print a Medicine Chart onto the other side. |
| CPAMS Templates | Description and Usage |
| TQ CPAM Consent Form | Print for patient to fill in. Store in patient history and file in pharmacy |
| TQ CPAM Invoice | Form can be used to invoice CPAM services |
| LTC Templates | Description and Usage |
| LTC1 to LTC8 | Required templates for delivery of the LTC service. Include Evaluation, Registration/Consent, Medicines Management, Annual Re-assessment. Exit & Transfer |
| LTC8 Transfer Request | Request from one pharmacy to another to exit the service so the patient can be re-registered at another pharmacy |
| TQ Doctor LTC Info Request | Request from pharmacy to prescriber for patient long term conditions and hospital admissions |
| LTC Leaflet | Print for patient information. Facilitates self-evaluation and details service for patient. Store in patient history |
| LTC Mental Health Diagnosis | Flowchart to help with evaluation of mental health condition. To decide if condition scores 10 points or 2 |
| TQ Heart Failure | Checklist for LTC patients with Heart Failure |
| Special Prescription Plan | |
| TQ Abbvie Care Pharmacy Programme | Patient counselling monthly checklist |
| TQ Maviret QUM | Quality use of medicines guide - Abbvie |
Using patient diary templates
Select a patient, press F10 Other and Open patient diary. Press F7 Use Tmplate and select the one required.
Creating your own template
Simple templates can be made by going to:
- 9. Other
- 5. Edit note templates
- then pressing F3 Add
- Names and other details that are to be pre-populated can be entered using options under F3 Patient field and F4 Other field
- the document can be formatted using the function keys
Word documents can be imported and then added-to, as long as they are saved as an rtf file. (within Word, press Save as and select Rich Text Format from the drop-down box below the file name as shown).
From within Edit note templates, press F10 Other and choose 2 Load from RTF file to import the document into Toniq.