Development Request Name(Required) First Last Role (Job title)Email(Required) PhonePlease state which practice you are from, or if you are not from a practice, the PCN, federation, ICB or other organisation(Required)Please select the clinical system you use(Required) EMIS Web SystmOne What is your TPP Org number or EMIS CDB (if practice based)?Please select if the request is referring to a(Required) New tool Existing PCIT tool Please select the existing resource's type(Required) Template Protocol Search/Report Which template is this referring to?(Required) OneTemplate Prescriber OneTemplate Non-Prescriber OneTemplate Admin OneTemplate Coding OneCalculator OneProcedure OneTravel Something else (please specify) Please specify the template page's name(Required)Example: The OneTemplate Admin contains a ‘Prescription Admin’ page, ‘Death Admin’, ‘Loans Equipment’ etc. It’s important to confirm the name of this so that we can quickly identify the area this request is regarding. Please specify the page's section name(Required)Example: Within the OneTemplate Admin, there’s a page for ‘Prescription Admin’, this consists of the following sections ‘Urgent prescription required’, ‘Prescription sent to pharmacy’, ‘Prescription not collected’ and ‘CD prescription collected’. It’s important to confirm the name of this so that we can quickly identify the area this request is regarding. Please specify the template's name/section(Required)Which search/report is this referring to?(Required)Please specify folder/search name as seen in the Primary Care IT folder (within population reporting).Which protocol is this referring to?(Required)Please specify protocol name as seen in box (HP***). Please note, if the protocol does not say ‘Powered by Primary Care IT’ then it is not a PCIT authored alert. Priority(Required)LowMediumHighUrgentJustification for level of priorityRequest title(Required)Summary of the requestPlease probide a brief overview of the development request.Please describe the details of the development request (for both new and existing tools)(Required)Please provide as many details as possible, including: the reason behind the development request, other details you think are relevant, the type of resource e.g: search/report, protocol, template, protocol alert (EMIS), patient status alert (SystmOne), OneContact, or OneAnalytics. If there are any specific codes or specification documents (e.g. for a locally enhanced service) please submit these with the request.What would this development allow you to do, which you can’t do currently?(Required)What guidance are you following when asking for this request?(Required)For example: NICE guidance, LES, DES, etc. if this relates to any business rules or specifications (please attach these below).Do you have any reference examplesPlease provide examples or references that illustrate what you’re looking for (if applicable)Please upload any supporting documentation for your requestMax. file size: 50 MB.Click here to view our development process support articleI confirm that I have read the support article about development requests and acknowledge that my request will be evaluated and dealt with in line with this process(Required) Yes
