NNUH FH Genomic Testing

Practice Pro-Forma

Eclipse, in collaboration with the NNUH (Norfolk & Norwich University Hospital), EGMSA (East Genomic Medicine Service Alliance)and AHSN (Academic Health Science Network), are working together to complete screening and referral for your at-risk patients (Cholesterol >7.5 or LDL >4.9) for genomic testing for FH.

This NHS programme is part of the national cardiovascular screening initiative.

Please complete the pro forma below to provide practice permissions for this service.

Practice Name

National Practice Code:

Programme Activation:

Identification of risk of FH and Genomic testing

Contacting Patients:
1. Are you happy for patients within the activated cohort to be contacted by the Eclipse automated patient engagement interface? (NB: this will involve SMS messaging):

Yes

No

2. Are you happy for patients within the activated cohorts to be contacted by a patient engagement team? (NB: this will involve telephone calls):

Yes

No

3. Are you happy for patients to receive a feedback questionnaire for evaluation of the programme and to allow them to express any personal preferences:

Yes

No

Key Contacts

Practice Admin Lead:

First Name

Last Name

NHS Email:

Practice Clinical Lead:

First Name

Last Name

NHS Email: