NISG –Caldicott Approval for Community Health Index (CHI) Matching in SCI Gateway

Health Boards must provide Caldicott Approval before a CHI Matching or CHI Matching & Referral To Treatment (RTT) Provider is added to SCI Gateway.
Completed forms should be submitted to the NISG Service Desk:

NB: Note that Caldicott approval will be required for each and every different group per Health Board and that the CHIAG reserve the right to rescind the authorisation should they be unsatisfied with any aspect of the process or group being authorised.
For SCI Store Providers it is assumed by NISG that Caldicott Approval has been already been agreed with the Health Board Caldicott Guardian and the Health Board therefore assumes responsibility for the staff having access.
Requestor:
HB/Site: / Tel. No.:
Email :
Caldicott Guardian: / Date Approved:
Access to CHI Approved:
Yes No / Date Approved:
Reason For Request (Tick Appropriate box):
CHI Matching CHI Matching & RTT
SCI Store Look up SCI Store Look up & RTT
0
0
SCI Gateway Health Board administrators will require the Demographic Provider Assignment capability to assign the Provider via the HCE Extra.
Demographic Provider Assignment capability required? Yes No
Name:
Username:
Signatory Declaration
I declare that I understand and undertake to abide by the rules for confidentiality, security andrelease of data as set out on page 2 of this document.
Name:
Designation:
Date:
RULES ON CONFIDENTIALITY, SECURITY AND RELEASE OF INFORMATION
NOTE FOR USERS OF CHI
  1. Data held by Health Boards on NHS patients has been notified under the Data Protection Act 1998 for the purposes of :
Research
Health Administration and Services
Accounts and Records
It cannot be used for any other purposes.
2.If the data received from Health Boards is to be held on computer, the signatory of this request, or the organisation(s) they represents, should have an appropriate notification with the Office of the Information Commissioner.. Whether stored on computer or otherwise, the signatory should be aware that the Data Protection Act 1998 requires that all personal data is processed fairly and in accordance with the Data Protection Principles.
  1. Data received from Health Boards should not be used for any purpose other than that declared on page 1 of this document.
  1. Proper safeguards should be applied in keeping the data to prevent any breach of confidentiality. Any misuse or loss of this data should be notified immediately to the Health Board.
  1. Any statistics or results of research based on data received from Health Boards should not be made available in a form which :
a)directly or indirectly identifies individual data subjects or creates a risk of indirect identification (if in doubt consult the local Health Board Caldicott Guardian before proceeding)
b)is not covered by the ‘intended use of data’ clause specified on page 1
FOR NISG Product Support Use:
Date received: / Date approval recorded: / Helpdesk No.
Responsible: