Hospital/Organisation
Address
Contact Phone Number
Workplace Supervisor
and/or Mentor
HLT31412 Certificate III in Hospital-Health Services Pharmacy Support & HLT40512 Certificate IV in
Hospital-Health Services Pharmacy Support
Resource, Facilities and/or equipment requirements
General facilities
Checklist/Notes (please
indicate if access is available)
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General
Technology
General Clinical
Workplace
information
Medical
Information
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dispensing medicines
Compounding
I declare that this workplace operates under the Practice Guidelines and Professional Practice Standards of
the SHPA.
Submit
Program Coordinator checks list and confirms with Trainer/Assessor that strategies for access have been discussed
with the Workplace Supervisor and/or Mentor.
Program Coordinator Signature: _______________________________ Date: __________________________________
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