Change of Surname

The PCT will advise the PPA when a nurse has changed their surname by using the appropriate Annex form.

PCT Nurse

PCT should complete the Annex A3.

Tick the box - Change of surname.

The proforma should be completed with the following details:

• Effective start date (this should be the date the nurse changed surname)
  
• Nurse UKCC PIN number
  
• Nurse name and initials (the surname and initials of the current name must be clearly printed)
  
• Change of surname - this should be the new surname
  
• Title (Mr/Mrs/Miss/Ms/Sister)
  
• Tick if qualified to prescribe from DN/HV formulary or extended formulary/supplementary prescriber
  
• PCT code or CNPC code
  
• PCT /CNPC address (Headquarters) (PCT headquarters address should be completed as this will be the address printed on the nurse prescription pad).

Practice Nurse

PCT should complete the Annex A2.

Tick the box - Change of surname.

The proforma should be completed with the following details:

• Effective start date (this should be the date the nurse changed surname)
  
• Nurse UKCC PIN number
  
• Nurse name (the surname and initials of the current name must be clearly printed)
  
• Change of surname - this should be the new surname
  
• Title (Mr/Mrs/Miss/Ms/Sister)
  
• Tick if qualified to prescribe from DN/HV formulary or extended formulary/supplementary prescriber
  
• PPA Practice code or code of Senior GP (GP's National Code Number)
  
• Practice/Senior GP name
  
• Main surgery address & telephone number (this will be the address and telephone number printed on the nurse prescription pad).

The PCT must :

• Order personalised nurse prescription pads from Astron using the Astron ordering procedure.
  
• Ensure that all unused FP10(P) prescription pads bearing the previous details are collected and destroyed in a secure manner.