Annual Monitoring Audit Form

Major change (approval) submission form for stand alone Prescription only medicines – sale / supply programmes

To help you complete this form please refer to the accompanying guidance

There are three sections of this form which need to be completed:  Section 1 About the stand alone Prescription only medicines – sale / supply programme  Section 2 Further information about the stand alone Prescription only medicines – sale / supply programme  Section 3 Confirmation

Section 1 – About the stand alone Prescription only medicines – sale / supply programme Name of education provider Name of awarding/validating body (if different from education provider) Programme title (stand alone Prescription only medicines – sale / supply programme title) Name of Department, School or Faculty (to which the programme belongs) Programme leader

Mode of delivery Full time Part time Other (please provide details)

Contact details for person responsible for submitting the form to the HCPC Name Job title Telephone number Email address Check list of documents required for stand alone programme:

 Module descriptor  Completed HCPC mapping document for SETs 2 and 3.3  Information for applicants  Admission / entry criteria  Monitoring and evaluation processes

If difference in academic level of stand alone programme to approved podiatry programme, further documents required:

 Assessment and learning outcomes for stand alone programme

Section 2 – Further information about the stand alone Prescription only medicines – sale / supply programme Are there any differences between the potential stand alone programme and the module within the HCPC approved chiropody / podiatry programme (academic level of programme for example)? If yes, please provide information on the differences

Have there been any recent changes in the curriculum content for this particular module? If yes, please provide information regarding the change

Are the facilities and resources provided, both on and off site, able to adequately support the learning and teaching activities of this programme?

Section 3 – Confirmation

I confirm that all information relating to the proposed stand alone Prescription only medicines – sale / supply programme which has been submitted is correct.

Job title Date

Please return this form to: Education Department, The Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU or [email protected]