Amend access / user removal form

Please complete the form below if you wish to amend user or remove user access to ICE.

ICE amend access/ user removal form

Section 1: Details of amendment/removal of an existing user/requester

Type of change?

Type of amendment?

New details

Reason for removal?

Section 2: Practice details

Main GP Practice Required

Practice code Required

Branch (if applicable)

Please list any other locations that this request covers

Section 3: Person details

Employee name Required

Contact telephone number Required

NHS email address Required

GMC number / professional reg number

GMP code (GPs only)

Job title / role Required

Professional registration number

Access rights request (select requesting access required). Only doctors with the required GMC certification are allowed GP access. AHPs need a valid IR(ME)R certification supplied to DGT Radiology, and be included on the practice Scope of Practice

Locum or GP Registrar

If Locum or GP Registrar post - please provide details of the supervisory Lead Clinician

If Locum post - which other surgeries do they have access to on ICE?

If the Locum already has access to ICE at any other surgeries please list them

Section 4: To be completed for IRMER Trained Practitioners only

Training details of IRMER qualified staff

Certificate(s) supplied to DGT Radiology - dgn-tr.irmer@nhs.net

Date(s) of course(s)

Updated SOP supplied to DGT Radiology - dgn-tr.irmer@nhs.net

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Page last reviewed: 4 April 2025

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Amend access / user removal form

ICE amend access/ user removal form

Section 1: Details of amendment/removal of an existing user/requester

Section 2: Practice details

Section 3: Person details

Section 4: To be completed for IRMER Trained Practitioners only

Address:

Tel:

Amend access / user removal form

ICE amend access/ user removal form

Section 1: Details of amendment/removal of an existing user/requester

Section 2: Practice details

Section 3: Person details

Section 4: To be completed for IRMER Trained Practitioners only

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