Amend access / user removal form

Please complete the form below if you wish to amend user or remove user access to ICE.

ICE amend access/ user removal form

Section 1: Details of amendment/removal of an existing user/requester

Type of change?

Type of amendment?

New details

Reason for removal?

Section 2: Practice details

Main GP Practice Required

Practice code Required

Branch (if applicable)

Please list any other locations that this request covers

NHS email address of person completing this form Required

Section 3: Person details

Employee name Required

Contact telephone number Required

NHS email address Required

GMC number / professional reg number

GMP code (GPs only)

Job title / role Required

Professional registration number

Access rights request (select requesting access required). Only doctors with the required GMC certification are allowed GP access. AHPs need a valid IR(ME)R certification supplied to DGT Radiology, and be included on the practice Scope of Practice

Locum or GP Registrar

If Locum or GP Registrar post - please provide details of the supervisory Lead Clinician

If Locum post - which other surgeries do they have access to on ICE?

If the Locum already has access to ICE at any other surgeries please list them

Section 4: To be completed for IRMER Trained Practitioners only

Training details of IRMER qualified staff

Certificate(s) supplied to DGT Radiology - dgn-tr.irmer@nhs.net

Date(s) of course(s)

Updated SOP supplied to DGT Radiology - dgn-tr.irmer@nhs.net

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Page last edited: 29 August 2025

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Amend access / user removal form

ICE amend access/ user removal form

Section 1: Details of amendment/removal of an existing user/requester

Section 2: Practice details

Section 3: Person details

Section 4: To be completed for IRMER Trained Practitioners only

Address:

Tel:

Amend access / user removal form

ICE amend access/ user removal form

Section 1: Details of amendment/removal of an existing user/requester

Section 2: Practice details

Section 3: Person details

Section 4: To be completed for IRMER Trained Practitioners only

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