Section 1: Your details

*Required field

Name *

First and last name

Telephone number

Email *

Section 2: Organisation details

Your organisation name *

Type of organisation * Select an option Trust Commissioning Support Unit (CSU) System supplier NHS Digital Other

Name of affected organisation if reporting on behalf of someone else

Section 3: Details of affected service

Affected service * Spine NHS e-Referral Service (e-RS) Care Identity Service (CIS) Test lab Other

Environment * Development Deployment Integration Training Opentest Non-functional testing (NFT) Other (please specify)

e-RS environment e-RS INT1 e-RS INT2 e-RS DEP1 e-RS DEV1 e-RS DEV3 e-RS TRAIN e-RS TRAIN2 Other (please specify)

CIS environment Development Deployment Integration Training Other (please specify)

Test lab environment (if known)

Section 4: Description of incident

Describe the problem *

Please provide as much information as possible to assist diagnosis including Message IDs, time/date stamps and party keys/ASIDs where relevant.

Section 5: Error messages

Was an error message received? * Select an option Yes (please specify) No Not applicable

Details of error message

Section 6: Smartcard details

Are you using a smartcard? Select an option Yes (provide UUID and version below) No

Provide UUID and version

Section 7: History

Has the issue you're reporting ever worked successfully? Select an option Yes No

Let us know when this worked successfully, providing any other details to help us identify and resolve the issue

Section 8: Replication steps

Provide step-by-step instructions to help us recreate the issue. Include as much information as possible, for example URL, role selection, option selection, NHS Numbers *

Section 9: Expected behaviour

Describe what you were trying to achieve (the business process) and how what you were expecting to happen differed from what actually happened

Section 10: Additional information

Provide any additional information you think may assist us, including local configuration or connection details and/or recent changes