The patient below is being referred to you under the PCP – Weight Management Programme for Mounjaro.

Patient has passed the eligible criteria and the patient has been sent the Registration Link.   Patient has been informed of the process and screening required.

Referring Pharmacist
Pharmacy Location
Name of Patient
Eligible for Mounjaro
Registration Link Sent
Patient Informed of Process

HSM will conduct it’s own review based on the registration  form submitted and forward The Pharmacy a Prescription for Mounjaro is appropriate by Signature Rx.  HSM will also organise the appropriate Blood Tests required and requested.

 

HSM will contact you if further information is required.

Clinical Medical Team

Harley Street Medical

pcp-referral@harleystreetmedical.co.uk