"*" indicates required fields What do you require access to? * REQUIRED ICE - to view results only through RiO ICE - to view results only through SystmOne PACS - access to both images and reports Your name * REQUIRED First Last Your email * REQUIRED Your role * REQUIRED Medical Secretary Medic Non-Medical Prescriber (NMP) Other Your job title * REQUIREDDepartment * REQUIREDSite/Location * REQUIREDContact Telephone Number * REQUIREDProfessional PIN (GMC, NMC, GPHC etc)For SystmOne Users What module of S1 the access is for?For SystmOne Users What is your reason for access? * REQUIREDLine manager's name * REQUIRED First Last Line manager's email * REQUIRED Confidentiality and the Data Protection ActI understand that if issued with a user account that this is for my personal use and that details of it must not be divulged to any other person to access the system as this would be a serious breach of confidentiality. I will not leave the system open for any other person to access information. I will change my password if I suspect that there has been a breach of security and it has become known to another person. I understand that in the course of my work, personal and clinical information about individual patients will be available to me. I am required not to talk about, discuss or inform any unauthorised person of such information. The Data Protection Act 1984 applies to ALL data stored and retrieved, e.g. printouts and labels from computer systems as well as data stored on the system. If you need to dispose of any printed material please ensure it will be burnt or shredded. You should also be aware that downloading data from this system to other sources is prohibited outside of the Trust, and that all data held upon the system remains the property of the Imaging Department. I will ensure all the data I am responsible for is accurate. Should I become aware of any inaccuracies for which I have no direct responsibility, I will inform the appropriate person. I understand that I should NOT review images on less than a 17” Flat screen monitor and should make a three point identity check on patient details. * REQUIRED I have read, understood and agree to abide by the above CAPTCHAEmailThis field is for validation purposes and should be left unchanged.