Order smartcard readers Use this form to order smartcard readers. Region and organisation Region * South London Midlands and East North National Organisation type * Commissioning Support Unit Clinical Commissioning Group Acute Trust Ambulance Trust Mental Health Trust Community Trust Non-NHS RA Service Provider Other ODS code* Organisation name* Delivery address RA manager name* Contact telephone number* Contact email address* Room* Department* Address line 1* Address line 2 Town/City* County* Postcode* Delivery instructions* Order details Order type * Card reader - USB (NHS organisations only - 100 per box) Card reader - Proximity ('Clean' keyboard area use only - 40 per box) Number of boxes* Current stock Which smartcard readers are in use in the recipient organisations? * Standard (Omnikey 3121) reader Contactless ‘clean’ (Omnikey 5321) reader Both Are the recipient organisations are using smartcard proximity readers, such as contactless readers for printers or door access? * Yes No Don't know Reason for order What's the business justification for your order? Deployment Business as usual (such as new starters) Junior Doctors intake Other Please expand on business justification selected. Approval is subject to review. * Any personal information you give to us will be processed in accordance with the UK Data Protection Act 1998. We will use the information to process your request and to provide any further relevant information or services you have requested. It will also be used to support our service development activities.