Liaison Form

Is it mandatory to use INESSS’s liaison forms?
When a medication is adjusted or changed, the liaison form can be used by the authorized person or the patient to forward this information to the community pharmacist. While this form is not mandatory, it can prove very useful as a reminder to forward information that will be required in some other way if the form is not used.

Can the institution change a collective or individual prescription template or a liaison form template to bring them in line with its practices?
Institutions are not required to use the collective prescription template suggested by INESSS or the CMQ; however, a collective prescription must contain all the elements stipulated in the Regulation respecting the standards relating to prescriptions made by a physician.

The liaison form templates can also be modified as needed by an institution. These documents are not mandatory as long as the required information about the patient is properly forwarded by the treating physician to the authorized professional, who will then use the collective prescription.

The only requirement is that INESSS’s medical protocol, which is mandatory, must be used in its entirety.

The liaison form provides only three spaces in which to indicate the medications; is this enough space?
There should be enough lines for the required medications if you indicate only the starting medications or those for which the dosage needs to be adjusted.

When an individual adjustment prescription is being used, does the liaison form need to be sent to the pharmacy each time the patient visits, even if no change in the dosage is required?
No. You must forward the information to the pharmacist if there in an adjustment in the drug dosage. In this case, you can use the liaison form. On the other hand, if no such adjustment is required, the pharmacist does not need to be notified, unless otherwise specified in the medical protocol.

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