New users access request form

New Users

Complete this form below.

You will recieve an email copy of the form once you have completed and submitted it. We will create new user accounts within five days, although we try to do this as quickly as possible.

ICE New User Information

Section 1: Practice details

Main GP Practice Required

Practice Code Required

Branch (if applicable)

Please list any other locations that this request covers

Section 2: Person details

Employee name Required

Contact telephone number Required

NHS email address Required

GMC number / professional reg number Required

GMP code (GPs only)

Job title Required

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 at the practice

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

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

Section 3: To be completed by IRMER Trained Practitioners Only

Training details of IRMER qualified staff

Date(s) of course(s)

Certificates supplied to DGT Radiology

Yes

Updated SOP supplied to DGT Radiology

Yes

I agree to the privacy policy.

Patients and Visitors

Fundraising

Cancel/Change an Appointment

Contact form

New users access request form

New Users

ICE New User Information

Section 1: Practice details

Section 2: Person details

Section 3: To be completed by IRMER Trained Practitioners Only

Training details of IRMER qualified staff

Address:

Tel:

New users access request form

New Users

ICE New User Information

Section 1: Practice details

Section 2: Person details

Section 3: To be completed by IRMER Trained Practitioners Only

Training details of IRMER qualified staff

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