Data Collection Sheet for Organisation Links Web Browser

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					Open Exeter Web Browser – Data Users Certification Form

                         Data Users Certification for Open Exeter Web Browser

All organisations must complete Parts A, B and C. A separate Data User Certificate
Part C must be completed for each User.

Once completed, please send to the Data Controller at the PCT, Agency, Shared
Services for completion of Part D. The Data Controller may process the application on-
line or forward to the NHS CFH Authentication Team.

Incorrect completion of this form will result in a delay in the processing of your
application.

                                               ORGANISATION SECTION

PART A - PLEASE PRINT

(*) Mandatory fields

Organisation Name (*) ..............................................................................

Address (*)                    ..............................................................................

                               ..............................................................................

                               ..............................................................................

                               ...................................... Post Code ......................

Organisation Code (*) ..............................................................................

NOTE:          Your Organisation Code will be used as a unique identification code.


Primary Contact (*)            ..............................................................................

NOTE:          (a)    The Primary Contact is important as this person will receive the user
                      names and passwords on behalf of all users.
               (b)    When completing a new application please ensure that the Primary
                      Contact name is the same as on previous applications.
               (c)    If the role of the existing Primary Contact changes we require written
                      notification from the existing Primary Contact stating new person’s
                      name, telephone number and email address.

Job Title                      ..............................................................................

Telephone No. (*)              ..............................................................................

Fax No.                        ..............................................................................

Email address(*)               ..............................................................................


Ref: oe39.doc                                                                                    Date:12th February 2010
Produced By: Duncan Larkman                                                                                 Version: 4.11
Open Exeter Web Browser – Data Users Certification Form

ORGANISATION SECTION
PART B
Why does your Organisation need access to this information? Please tick appropriate boxes.

     Re-directing letters sent to wrong GP                                 (Patient Details/Access to patient data)

       Confirming patient/GP details                                                                        (Patient Details/Access to patient data)

       Checking for duplicates when 2 people on the system have similar
        details
                                                                                                             (Patient Details/Access to patient data)


       Confirm NHS Number                                                                                   (Patient Details/Access to patient data)

       Checking GP for in-patients                                                                          (Patient Details/Access to patient data)

       Verifying Patient Details                                                                            (Patient Details/Access to patient data)

       Checking waiting lists                                                                               (Patient Details/Access to patient data)

       Ensuring integrity of trust database                                                                 (Patient Details/Access to patient data)

       For despatching results to registered GP                                                             (Patient Details/Access to patient data)

       Confirming registration details for Emergency Admissions                                             (Patient Details/Access to patient data)

       Outpatient clinic appointments to confirm NHS number                                                 (Patient Details/Access to patient data)

       Pre-admissions to check NHS Number/GP                                                                (Patient Details/Access to patient data)

       Tracing NHS numbers                                                                                  (Patient Details/Access to patient data)

       Previous Breast Screening history                                                                    (Patient Details/Access to patient data)

       Ensuring details of treatment passed to correct GP                                                   (Patient Details/Access to patient data)

       Sending case sheets for payment to correct GPs                                                       (Patient Details/Access to patient data)

       Checking for cervical screening history                                                              (Cytology Report)

       Assist in Cervical Screening Programme                                                               (Cytology)

       Cytology – Electronic Prior Notification List & E-Cards                                              (Cytology)

       Register Blood Donors                                                                                (Blood donor, including Update)

       Register Organ Donors                                                                                (Organ donor, including Update)

       Monitor Payments                                                                                     (GP Statements
                                                                                                             Childhood Immunisations - Historic
                                                                                                             Vaccinations & Immunisations
                                                                                                             Drug Payments
                                                                                                             Temporary Residents & Emergency Patients)

       Provide GP Lists                                                                                     (GP index)

       Check Breast Screening Status                                                                        (Breast Screening)

       View Prescription Exemption Status                                                                   (Prescription Exemption)

       GP Capitation Counts                                                                                 (Capitation Counts)

       Access to patient’s test results                                                                     (Patient Details/Access to patient data)

       Monitor internal use of Open Exeter                                                                  (Caldicott Guardian – this is an Open Exeter Auditing
                                                                                                             Facility)

       Childhood Immunisation Returns                                                                       (Payments)

       Provision of Home Oxygen to patients                                                                 (GP Home Oxygen – Secondary Care Home Oxygen)

       Home Oxygen for PCTs                                                                                 (PCT’S only - Home Oxygen)

       Ophthalmic Payments
        Security Policy Schedule D: NHS-wide ophthalmic payments
                                                                                                             (Ophthalmic Payments)


If not covered by any of the above, please specify:

        ........................................................................................................................................................................

        ........................................................................................................................................................................
I certify that all persons named as data users in the attached sheets have justifiable need to access the data for reasons shown above.


Signed (Primary Contact)………………………………………………………………..                                                                                        Date ………………….




Ref: oe39.doc                                                                                                                  Date:12th February 2010
Produced By: Duncan Larkman                                                                                                               Version: 4.11
Open Exeter Web Browser – Data Users Certification Form

                                                        ORGANISATION SECTION
                                                     Open Exeter Data User Certificate
PART C
Full Name (Please Print) .............................................................................

E-mail address ............................................................................................

Job Title             .............................................................................................

Existing Open Exeter User Code ...............................................................
Applications:-
 Batch Exeter System Search (requires Patient Detail)
 Blood Donor (Display / also Update**) (**please delete if Update not applicable)
 Blood Donor Statistics (for PCT organisations only)
 Breast Screening Batches
 Breast Screening Episodes
 Caldicott Guardian Audit Report & Statistics (for Organisation/for Exeter System**)
 Cytology Report (essential for Electronic Prior Notification Lists & E-Cards)
 HPV Vaccinations
 Cytology – Electronic Prior Notification List & E-Cards (Requires cytology reports. For GP organisations only)
          Email address(es) for notifications

    Email: ------------------------------------------------------------- cc: -----------------------------------------------------
 Doctors Details
 GP Capitation Counts
 GP Home Oxygen (for GP Organisations only)
 GP Patients Index (for GP Organisations only)
GP Finance Applications (for GP Organisations only)
 GP Statements
 Childhood Immunisations (Historic)
 Vaccinations and Immunisations
 Drug Payments
 Temporary Residents & Emergency Patients
 Notification Email address(es) for GP Statements (for GP Organisations only)
          Email address(es) for notifications (Maximum of 69 characters, including separating semicolons)

      --------------------------------------------------------------------------------------------------------------------------
 Childhood Immunisations Lists (for GP Organisations only)
          Email address for notifications (ONLY one email address per GP Practice)

     ------------------------------------------------------------------------------
 Childhood Immunisation Returns (for PCTs only)
 Home Oxygen (for PCTs only)
 Secondary Care Home Oxygen (for Respiratory Teams)
 Organ Donor (Display / also Update**) (**please delete if Update not applicable)
 PCT Finance (for PCTs only)
 Patient Detail
Signature of authorised Data Controller:                                                                     Date:


Ref: oe39.doc                                                                                                  Date:12th February 2010
Produced By: Duncan Larkman                                                                                               Version: 4.11
Open Exeter Web Browser – Data Users Certification Form

………………………………………………………………………………………………………………………………




Ref: oe39.doc                                             Date:12th February 2010
Produced By: Duncan Larkman                                          Version: 4.11
         Open Exeter Web Browser – Data Users Certification Form

                                                  EXETER SYSTEM DATA CONTROLLER SECTION
         Part 1 of 2

         PART D
PART D
  (a)    PCT’s Exeter System(s)......................................................................................................................

         Data Controller’s Contact ....................................................................................................................

         Address .............................................................................................................................................

                       ……………………………………………………………………………………………..................

         Telephone No: …………………………….

         E-mail address ………………………………………

         This is to authorise connection for …………………………………….…………….. (Name of Organisation)

         -------------------------------------------------------------------------------------------------------------------------------------------------

PART D   Search Criteria to be applied & View Patient/GP Info                                   (if not specified will default to YES)
  (b)
                                                                                                             Please circle as appropriate

         Surname and Forename only searches permitted                                                    YES        NO

         Date of Birth only searches permitted                                                           YES        NO

         Enable wildcard name searches                                                                   YES        NO

         View Patient Address info required                                                              YES        NO

         View Patient GP info required                                                                   YES        NO

         Data Filters to be applied - Leaving the fields blank will mean that no filters will be applied.


         Sex (M/F)                   .............................      Age Range                         ...................

         DOB Range                   .............................      Q Codes (up to 5)                 ................... ……… ..........

         GP Codes                    .............................      Partnership Codes                 ...................     ................

                                     .............................      PCT of Registration               ...................     ................

         Practice Codes              .............................      PCT of Residency                  ...................     ................


         Signed……………………………………………………Signature of authorised Data Controller

         Date………………………..

         PLEASE NOTE:

         PAGES 1 & 2 OF PART D MUST BE SIGNED BY A DATA CONTROLLER, FAILURE TO
         DO SO WILL RESULT IN A DELAY IN THE PROCESSING OF THIS APPLICATION

                                                                                                                                                     Continued


         Ref: oe39.doc                                                                                                 Date:12th February 2010
         Produced By: Duncan Larkman                                                                                              Version: 4.11
         Open Exeter Web Browser – Data Users Certification Form

         Part 2 of 2        Part D cont..

         Applications enabled on Exeter System    (Please Mark Box with X)
PART D                     (*) MANDATORY FIELDS (**) PLEASE DELETE AS APPROPRIATE
  (c)

          Patient Detail
          Breast Screening Episodes (Patient Details required for this application)
          Breast Screening Batches & Episodes for a Screening Office (*SO Code: ………) (Patient Details
             required for this application)
          Blood Donor Statistics – PCT Organisations
          NHS Blood Donor Register (Display/also **Update- please delete if Update not applicable)
          NHS Organ Donor Register (Display/also **Update - please delete if Update not applicable)
          Cytology Report (Patient Details required for this application)
             Allow production of HMR101 from age   [         ]   Default age is 24
          HPV Vaccinations (Patient Details required for this application)
          Cytology - Electronic Prior Notification List & E-Cards GP Organisation only (Please tick if appropriate)
             e-PNL:

             Update PNLs via browser & manual update – No email / Notify via email**   (delete as appropriate)

             e-Cards:

             Update eCards via Browser & manual update – No email / Notify via email** (delete as appropriate)
             Print electronic cards YES / NO**
             Women recently ceased: Enable browser view & manual update – No email / Notify via email**
             Women recently registered and currently ceased: Enable browser view & manual update – No email / Notify via email**
             First non-responder: Enable browser view & manual update – No email / Notify via email**
             Final non-responder: Enable browser view & manual update – No email / Notify via email**
             Abnormal Follow Up: Enable browser view & manual update – No email / Notify via email**
          GP Finance Applications (*Senior Partner Local Code : …………) GP Organisation Only
              GP Finance applications include, GP Statements, Childhood Immunisations (Historic),
              Vaccinations and Immunisation, Drug Payments, Temporary Residents & Emergency Patients
                                    (**please delete applications not applicable)

              Make GP Statements available from this date: ……………………………………………………….......
          GP Index of Patients (*requires Data Filters, see above) - GP Organisation Only
          GP Capitation Counts (*requires Data Filters, see above)
          GP Home Oxygen - GP Organisation Only (Patient Details required for this application)
          Secondary Care Home Oxygen – Respiratory Teams (Patient Details required for this application)
          Doctors Details
          Caldicott Guardian Audit Report (for Organisation / for Exeter System**)
          PCT Finance - PCTs Only
          PCT Home Oxygen – PCTs Only (Patient Details required for this application)
          Childhood Immunisation Lists - GP Organisation Only (Please tick if appropriate)
                 Allow Capitation Adjustment……
                 Suppress Prints……
                 Fringe Practice……

         Signed……………………………………………………Signature of authorised Data Controller

         Date………………………..
         PLEASE NOTE:
         PAGES 1 & 2 OF PART D MUST BE SIGNED BY A DATA CONTROLLER, FAILURE TO
         DO SO WILL RESULT IN A DELAY IN THE PROCESSING OF THIS APPLICATION
         Ref: oe39.doc                                                                          Date:12th February 2010
         Produced By: Duncan Larkman                                                                       Version: 4.11
Open Exeter Web Browser – Data Users Certification Form


                              Information to enable the completion of the
                                    Data Users Certification Form

ORGANISATION

Part A

An organisation wishing to obtain access to an Exeter System’s (i.e., PCT, Agency, Shared
Services) data must first complete Part A with the Organisation’s name, address, national code and
Primary Contact.

Primary Contact

The Primary Contact is important as this person will receive the user names and passwords on
behalf of all users.

When completing a new application please ensure that the Primary Contact name is the same as on
previous applications.

If the role of the existing Primary Contact changes we require written notification from the existing
Primary Contact stating new person’s name, telephone number and email address.

Part B

This must also be completed and signed by the Primary Contact.

To comply with the current Data Protection Act, an organisation must inform the Exeter System
Data Controller why access to the data is required. If your requirements are not covered by the list
in Part B, enter your reason for connection in the space provided.

Part C

An individual User Certificate must be completed for each user requiring access to the System ,
including the Primary Contact, (photocopy Part C for any additional users). There is no limit to the
number of users at an organisation.

The Exeter System’s Data Controller will sign each User Certificate.

Part D

Please attach a blank copy of Part D with your application (the Exeter System’s Data Controller
must then complete this section).

The completed application can now be forwarded to the Exeter System’s Data Controller at the
PCT/Agency/Shared Services for which access is required. The Data Controller will either process
the application themselves, on-line, or forward the whole application to the NHS Connecting for
Health Authentication Team for processing.

General

Once your application has been processed, the Primary Contact will receive a telephone call from
the NHS Connecting for Health Help Desk informing them of User IDs and Passwords.

There is no limit to the number of Exeter System connections an Organisation may have. However,
each connection must be approved by the relevant Exeter System’s Data Controller.
Ref: oe39.doc                                                         Date:12th February 2010
Produced By: Duncan Larkman                                                      Version: 4.11
Open Exeter Web Browser – Data Users Certification Form




Ref: oe39.doc                                             Date:12th February 2010
Produced By: Duncan Larkman                                          Version: 4.11
Open Exeter Web Browser – Data Users Certification Form

EXETER SYSTEM DATA CONTROLLER

The Chief Executive will authorise an Exeter System’s Data Controller as a valid signatory by completing a
Data Controller Certification Form, and this form will be used to verify all signatures.

The same Exeter System’s Data Controller may be nominated by more than one PCT/Agency/ Shared
Services, especially where Agencies operate multiple Exeter Systems on behalf of several areas.

Exeter System Data Controllers must complete the following:
Part D (a)

Completion is mandatory.

Part D (b)

All must be circled, either YES or NO. Failure to do so will result in these being defaulted to YES.

        Surname and Forename Only searches permit an organisation to search using both Surname and
         Forename and returns a list of possible matches.

        Date of Birth Only searches permit an organisation to search using just the patient’s Date of Birth
         and this returns a list of possible matches.
        If Date of Birth Only, Surname and Forename Only are not specified, users will be required to
         enter all three fields for a search to take place.
        Enable wildcard name searches permits an organisation to search using wildcards for example,
         (BLOGGS J*) , (B* JOE) , (B* J*).

        View Patient Address info required - indicates if patient address details are to be presented to an
         organisation.

        View Patient GP info required - indicates if a patient’s GP details are to be presented to an
         organisation.

Data Filters to be applied - Please complete this section if an organisation’s access is to be restricted.

Part D (c)

Please complete and sign as necessary, noting mandatory fields. Failure to supply mandatory fields will
result in these ‘specific applications’ not being applied.

Part C

The authorised Exeter System’s Data Controller must sign for each ‘Data User Certificate’ Part C.

General

When the Data Controller is satisfied that the application has been completed appropriately, the Data
Controller will sign Part C and complete & sign Part D. The application will then be forwarded to NHS
Connecting for Health, Authentication Team for activation of the Data Users' accounts or, alternatively, the
Data Controller may use the on-line Organisation Maintenance function to process the application.

The fax number below is only for Data Controllers

The fax number is 01392 206757. The postal address is NHS Connecting for Health, Authentication
Team, Hexagon House, Pynes Hill, Rydon Lane, Exeter, EX2 5SE.

If you have any queries regarding your application please telephone the NHS Connecting for Health’s Help
Desk on 01392 251289 quoting ‘Authentication’ and one of the following categories, giving a brief
explanation of your query:

                                 Open Exeter , Detail Change

Ref: oe39.doc                                                               Date:12th February 2010
Produced By: Duncan Larkman                                                            Version: 4.11
Open Exeter Web Browser – Data Users Certification Form


You will be given an individual log number and your query will be dealt with accordingly.




Ref: oe39.doc                                                              Date:12th February 2010
Produced By: Duncan Larkman                                                           Version: 4.11

				
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