About you

Your full name *

Email address *

Job title *

Telephone number *

No spaces

About your organisation

Organisation name *

Organisation Data Service (ODS) code

Organisation type *

Acute trust, GP practice or private provider, for example.

Organisation web page address

Care setting for NCRS use *

Mental health, GP out-of-hours or care home, for example

About your NCRS access

Which services do you want to access in NCRS?

• Personal Demographics Service (PDS) - including the ability to edit patient demographic information
• Summary Care Records (SCR) - Core and Additional Information
• National Record Locator Service (NRL) – pointers to and retrieval of data held in local provider systems
• Child Protection - Information Sharing service (CP-IS)
• Reasonable Adjustment(s)
• Female Genital Mutilation - Information Sharing (FGM IS)
• Overseas Visitors and Migrants (OVM)
• Coronavirus (COVID-19) vaccination event information
• Birth Notification Application (BNA)

What will you use NCRS for and how will it improve delivery of care? *

Your preferred method of connecting to NCRS * Please select National Care Records Service (NCRS) Integration of NCRS functionality within system to launch NCRS Unknown

Please provide the name of the supplier and the system/solution

If you are a private sector provider, are you a member of any of the following? Please select Independent Health Provider Network (IHPN) Digital Health Council (DHC) NHS organisation Other

If you are a private sector provider, are you providing any NHS commissioned services?

• Yes
• No
• Not applicable

If yes or no, please provide further details:

Does your organisation have access to Personal Demographics Service (PDS)? *

• Yes
• No
• Don't know

If yes, what is your PDS reference number from a previous submission (if known)?

Does your organisation currently use smartcards or other CIS2 authentication methods? *

• Yes
• No

Please add any other supporting information