Weekly Submission Covid-19 Pharmacy Collect NI Lateral Flow Test

Data must be entered on this eForm once–weekly on a Monday for transactions carried out on the preceding 7 days.
Contractor Number & Pharmacy Details*
Week Ending*
DD slash MM slash YYYY
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Total Number of Lateral Flow Test Kits Supplied*
Total number of transactions*
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Reasons
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Number for child at school / work at a school / bubble with school children or staff*
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Number for leave the house for work*
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Number for GP / Healthcare Professional advised me to test*
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Number for other reason*
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Please use this box to record any reasons for supply of LFD test kits other than those noted above.*
note: this box should not be used to record anything else as it is only to detect common themes not currently captured in existing questions. Other issues / queries recorded here cannot be actioned so should be directed to your local Integrated Care Office as normal
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Total Number of Reasons*
This total should match total number of transactions
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Age Groups
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Number for age group under 18*
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Number for age group 18 - 24*
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Number for age group 25 - 34*
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Number for age group 35 - 44*
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Number for age group 45 - 54*
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Number for age group 55 - 64*
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Number for age group 65 and over*
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Total Number of Age Groups*
This total should match total number of kits supplied

Reasons