ICE create user/amend access/user removal form

Section 1: Details of amendment/removal of an existing user/requester

Type of change?

New user User amendment User removal

Type of amendment ^*

New details

Reason for removal? (if relevant)

Section 2: Practice details

Main GP Practice ^*

Practice code ^*

Branch (if applicable)

Please list any other locations that this request covers

Section 3: Person details

Employee name ^*

Contact telephone number ^*

NHS email address ^*

GMC number / professional reg number

GMP code (GPs only)

Job title / role ^*

Professional registration number

Access rights request (select requesting access required)

GP IRMER AHP View only

Only doctors with the required GMC certification are allowed GP access. AHPs need a valid IR(ME)R certification supplied to EKHUFT Radiology, and be included on the practice's Scope of Practice and Scope of Entitlement.

Locum or GP Registrar

If Locum or GP Registrar post - please provide details of the supervisory Lead Clinician

If Locum post - which other surgeries do they have access to on ICE?

Section 4: To be completed for IRMER Trained Practitioners only

Training details of IRMER qualified staff

Certificate(s) supplied to EKHUFT Radiology - ekhuft.radiologyscopes@nhs.net

Yes No

Date(s) of course(s)

Updated SOP supplied to EKHUFT Radiology - ekhuft.radiologyscopes@nhs.net

Yes No