Contact email address:
Organisation name:
ODS code (your ODS code is provided by the Organisation Data Services team at NHS Digital. Leave blank if you do not have one):
Have you completed your Data Security and Protection Toolkit (DSPT) assessment and achieved Standards Met? YesNoNot sure
Please provide the names and roles of the people in your organisation who will need access to patient data, and if they hold current registration with NM, GMC or other relevant body. Leave blank if you're unsure at this stage:
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