To request access to the Health and Social Care Data please complete the details below.

This information will be checked against the Information Sharing Protocol and Service Level Agreement relevant to your organisation. If your access request is valid it will be forwarded to the appropriate authoriser for consideration.

If your request is authorised, you must be trained to use the system. Your access will not be set up until training is arranged at which time you will receive details of your username and password.

Title:
 
First Name:
 
Surname:
 
Health Board / Local Authority:
 
Job Title:
 
Email:
  
Confirm Email:
 
Work Telephone:
 
If you have a NSS issued username, please add details here:

Reason For Access

Please give reason for access:
 

Line Manager

First Name:
 
Surname:
 
Please confirm this request has been discussed with line manager:
 
Email:
   
Confirm Email:
 
Work Telephone:
 

Request

Access Type:
 
User Type:
 
Select Partnership: