{"id":8056,"date":"2020-08-23T16:32:43","date_gmt":"2020-08-23T15:32:38","guid":{"rendered":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/?page_id=8056"},"modified":"2020-11-05T15:17:57","modified_gmt":"2020-11-05T15:17:57","slug":"repeat-prescription-request","status":"publish","type":"page","link":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/clinics-and-services\/repeat-prescriptions\/repeat-prescription-request\/","title":{"rendered":"Repeat Prescription Request"},"content":{"rendered":"\n<p>Order your repeat prescriptions online with the form below. You must be registered with the Practice before we can accept your request. <\/p>\n\n\n\n<p class=\"has-nhs-yellow-background-color has-background\"><strong>Please note:<\/strong>\u00a0For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission. It is important to enter your correct email address failure to do so will result in non-delivery of your request.<\/p>\n\n\n<link rel='stylesheet' id='formidable-css' href='https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=4271636' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_big_text\" id=\"frm_form_34_container\" data-token=\"8e4497ab7dd7057749543f9c07b531d4\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_hnlsj6313\"  data-token=\"8e4497ab7dd7057749543f9c07b531d4\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Repeat Prescription Request<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"34\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_34\" id=\"frm_hide_fields_34\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"hnlsj6313\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_34\" name=\"frm_submit_entry_34\" value=\"37fe3c57f4\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/8056\" \/><div id=\"frm_field_866_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_xu1tj63132\" class=\"frm_primary_label\">First Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xu1tj63132\" name=\"item_meta[866]\" value=\"\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_867_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_xt7az63132\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xt7az63132\" name=\"item_meta[867]\" value=\"\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_868_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ppbxb63132\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_ppbxb63132\" name=\"item_meta[868]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ppbxb63132\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ppbxb63132\">Enter Email<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_869_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_w1eya63132\" class=\"frm_primary_label\">Date of birth\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_w1eya63132\" name=\"item_meta[869]\" value=\"\"  data-frmmask=\"99\/99\/9999\" style=\"width:200px\" placeholder=\"DD\/MM\/YYYY\" data-reqmsg=\"Date of birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   aria-describedby=\"frm_desc_field_w1eya63132\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_w1eya63132\">Please use format day\/month\/year e.g. 12\/05\/1979<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_870_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_spq8l43132\" class=\"frm_primary_label\">Your phone number (this must be a UK number)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_spq8l43132\" name=\"item_meta[870]\" value=\"\"  data-reqmsg=\"Your phone number (this must be a UK number) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_871_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h2>Prescription Items<\/h2>\n<p>Copy exactly the details from a prescription slip you have received from the practice. <em>e.g. Loratadine 10 mg<\/em><\/p>\n<p>Please note that items will only be dispensed if they are included in a prescription from the practice and a medication review is not pending.<\/p>\n<\/div>\n<div id=\"frm_field_872_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_52ks4\" class=\"frm_primary_label\">Item 1\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_52ks4\" name=\"item_meta[872]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_873_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rhrsx\" class=\"frm_primary_label\">Item 2\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rhrsx\" name=\"item_meta[873]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_874_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6rasb\" class=\"frm_primary_label\">Item 3\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6rasb\" name=\"item_meta[874]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_875_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6kmlz\" class=\"frm_primary_label\">Item 4\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6kmlz\" name=\"item_meta[875]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_876_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rgh4e\" class=\"frm_primary_label\">Item 5\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rgh4e\" name=\"item_meta[876]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_877_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gh4pn\" class=\"frm_primary_label\">Item 6\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gh4pn\" name=\"item_meta[877]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_878_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_admoj\" class=\"frm_primary_label\">Item 7\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_admoj\" name=\"item_meta[878]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_879_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5u3lo\" class=\"frm_primary_label\">Item 8\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5u3lo\" name=\"item_meta[879]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_880_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_k4esf\" class=\"frm_primary_label\">Item 9\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k4esf\" name=\"item_meta[880]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_881_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7le0y\" class=\"frm_primary_label\">Item 10\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7le0y\" name=\"item_meta[881]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_882_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_upnnz\" class=\"frm_primary_label\">Special Medication Request\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[882]\" id=\"field_upnnz\" rows=\"5\"  data-invmsg=\"Special Medication Request is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_upnnz\"><\/textarea>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_upnnz\">Please Note: Special requests may not be authorised by the Doctor.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1201_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9no4j\" id=\"field_9no4j_label\" class=\"frm_primary_label\">Name and address of Pharmacy for collection\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9no4j\" name=\"item_meta[1201]\" value=\"\"  data-reqmsg=\"Name and address of Pharmacy for collection cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_9no4j\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_9no4j\">Please arrange this with your pharmacy<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_884_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Privacy Policy<\/h3>\r\n\r\n\r\n<div id=\"frm_field_885_container\" class=\"frm_form_field  frm_html_container form-field\">This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our <a href=\"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/about-us\/practice-policies\/patient-record\/how-we-use-your-data\/privacy-policy\/\" target=\"_blank\">Privacy Policy<\/a> to discover how we protect and manage your submitted data.<br \/>\nPlease note: For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear to indicate successful submission.<\/div>\n<div id=\"frm_field_886_container\" class=\"frm_form_field form-field  frm_required_field frm_inline_container vertical_radio\">\r\n    <label for=\"field_4oeoa2\" class=\"frm_primary_label\"> \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_886-884-0\"><label for=\"field_4oeoa2-0\"><input type=\"checkbox\" name=\"item_meta[886][]\" id=\"field_4oeoa2-0\" value=\"I consent to the practice collecting and storing my data from this form.\"  data-sectionid=\"884\" data-reqmsg=\"We need your consent to proceed. Please tick the box to consent.\" data-invmsg=\"  is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> I consent to the practice collecting and storing my data from this form.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1873_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_jv1k0_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_jv1k0\" class=\"g-recaptcha\" data-sitekey=\"6Ld0O9weAAAAAKDIPXELTJ97iWLMd3ZnPLGzcgiH\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__654f9b232c699\">\n\t\t\t\t<label for=\"frm_email_34\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_34\" type=\"text\" class=\"frm_verify\" name=\"frm__654f9b232c699\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"JuVaqbDyztKR+V7IKDnq85IMI3nX56gxF6DE05ACJck=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Send<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Order your repeat prescriptions online with the form below. You must be registered with the Practice before we can accept your request. Please note:\u00a0For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear &#8230; <a title=\"Repeat Prescription Request\" class=\"read-more\" href=\"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/clinics-and-services\/repeat-prescriptions\/repeat-prescription-request\/\" aria-label=\"Read more about Repeat Prescription Request\">Read more<\/a><\/p>\n","protected":false},"author":6577921,"featured_media":0,"parent":22,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","_uag_custom_page_level_css":"","footnotes":"","_links_to":"","_links_to_target":""},"acf":[],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"mailpoet_newsletter_max":false},"uagb_author_info":{"display_name":"Editor","author_link":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/author\/gary-genpra\/"},"uagb_comment_info":0,"uagb_excerpt":"Order your repeat prescriptions online with the form below. You must be registered with the Practice before we can accept your request. Please note:\u00a0For reasons of privacy this form will not store your details or medication request. There is no email acknowledgement with this service. Once you send this form a notification message will appear&hellip;","publishpress_future_action":{"enabled":false,"date":"2024-05-05 16:07:25","action":"change-status","newStatus":"draft","terms":[],"taxonomy":""},"_links":{"self":[{"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/pages\/8056"}],"collection":[{"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/users\/6577921"}],"replies":[{"embeddable":true,"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/comments?post=8056"}],"version-history":[{"count":0,"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/pages\/8056\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/pages\/22"}],"wp:attachment":[{"href":"https:\/\/www.butterbigginsmedicalcentre.scot.nhs.uk\/wp-json\/wp\/v2\/media?parent=8056"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}