Partner details

Organisation name * This is the organisation responsible for the integrated application

Contact name * First name and last name

Email address *

Date of use case approval * DD/MM/YYYY

Application details

How will your application access the e-RS FHIR API *

User restricted, healthcare worker access application:

APIM application name *

APIM application ID *

Application restricted, unattended access application:

APIM application name *

APIM application ID *

For your User-restricted, healthcare worker access application:

APIM application name *

APIM application ID *

For your Application-restricted, Unattended access application:

APIM application name *

APIM application ID *

Authentication

Authenticating users is a requirement of setting up e-RS for test purposes on the integration environment. Users will need to log into the e-RS professional application to create services, workgroups and referrals.

Which authenticator device (such as smartcards or security keys) will your integration test users authenticate with? *

For partners wishing to use smartcards, please provide your postal address so these can be sent to you

Patient administration system (PAS)

If you are intending to use directly bookable services, you will require a PAS to supply appointment slots to e-RS.

Do you have your own PAS to use in the test environment?

Yes
No - I don't need a PAS
No - but I require a test PAS

If yes

Please be aware that you will need to configure both services and slots on your PAS, and any services you create in e-RS to point to your PAS.

If no

We can provide a PAS if you do not have your own. We provide a test PAS as a courtesy to allow functional testing. Use of the test PAS is at your own risk. NHS England will not accept responsibility for missed test schedules.

Please read and confirm

By submitting this form, I understand and agree to the following:

Any personal information you give to us will be processed in accordance with the e-RS FHIR API integration privacy statement (below). 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.

I understand and agree