EKHUFT User Registration for GPs

Your details

Title

First name

Middle name

Last name

Email address

Phone number

Date of birth

National insurance number

Professional registration

GMC registration number for example

GP’s ODS prescribing code

Start date for access required

Final working day if known

Permanent or locum?

Permanent Locum

Smartcard UUID

Role

Clinical Support

Role / job title

Practice Information

Current Practice Name

Current Practice Address and Postcode

Current Practice Telephone

Current Practice Office Email Address

Current Practice Code

New Practice Name (if applicable)

New Practice Code (if applicable)

Transfer of laptop ownership

Asset number (of laptop changing ownership)

Name of current owner

Once this form has been submitted it will be reviewed to check it is an appropriate application and dealt with accordingly.

Anything else?