About you

Your name *

First name and last 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 SCR use *

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

Supporting information

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

Your preferred method of connecting to SCR * Please select An integrated viewer within an existing clinical system Integration of NCRS functionality within systems to launch NCRS Spine Mini Service SCR FHIR API (this API is initially for use by new market entrant GP IT developers, with other use cases to follow later) National Care Records Service (NCRS) Unknown

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

Please specify

Please specify the organisation you are a member of

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

• Yes
• No
• Don't know

Does your organisation currently use Smartcards? *

• Yes
• No

Does your organisation have an HSCN connection? *

• Yes
• No
• Don't know

Please add any other supporting information