• Review and complete the National Clinical Pharmacy Specialist (NCPS) Application Form, which contains a checklist of all required supporting documents and directions for submission.
• Supporting documents may be combined with the required NCPS forms as a single pdf or as separate attachments in a single email.
• Be sure the protocol you submit has been approved by the facility’s Medical Staff (not just one physician).  The names and signatures on the protocol(s) must include the Clinical Director (and/or Medical Staff President) and the Chief of Pharmacy Services.  In addition, the protocol should contain the date the protocol initially became effective and dates of reviews and/or revisions.
• Your clinical pharmacy supervisor and/or supervising physician should complete the NCPS Letter of Attestation.
• The NCPS Patient Encounter Log OR Inpatient Clinical Interventions Log should be completed to document the required number of patient encounters / interventions and must be signed by the supervising pharmacist or collaborating physician, as well as the local or regional chief pharmacist.
• Each applicant must submit clinical outcomes in at least two areas of care. If the areas of care provided have NCPS-standardized outcomes reporting forms, the applicant must report their data using those forms. If the applicant is providing care in areas where the NCPSC has not standardized reporting requirements, the applicant may report the outcomes he/she tracks, such as baseline and average PHQ-9 scores for depression or days of redundant therapy for antimicrobial stewardship.
• NCPS applicants are required to show documentation of being credentialed and privileged through local facility’s medical staff as of January 2019.  If the pharmacist is not able to meet this requirement, a Credentialing and Privileging Waiver Form is required.
• Applications are due one month before the NCPS Committee’s quarterly protocol review meetings on the second Wednesdays in February, May, August, and November. Incomplete applications will not be considered, and late submissions may be deferred to the next quarterly meeting.

If you have never been NCPS-certified or were initially certified prior to August 2017, you must complete the initial certification application form:

• NCPS Certification Application

If you were initially certified after August 2017 under the revised criteria, you may complete the Recertification Application:

• NCPS Recertification Application

• Applicant Encounter Log

• Applicant Inpatient Intervention & Case Log

• Applicant Attestation Letter

• Credentialing and Privileging Waiver (As applicable)

• Anticoagulation

• NCPS Anticoagulation Resource Guide

• Asthma

• Diabetes

• Hepatitis

• HIV

• Hypertension

• Pain

• Chronic Medication Refills

• Seizure

• Tobacco Cessation