e-Referral Service dashboard (private version) – access request form

Apply for access to the e-Referral Service (e-RS) dashboard (private version).

Before you start

Who can apply

You can apply for access if you have one of the following provider roles:

clinician
information analyst
operational staff
administration staff

Personal data

Personal data collected during this process will only be used to onboard and manage the users of the e-RS dashboard (private version). It will not be used for any other purpose.

Terms and conditions

To submit the access request form, you will be asked to confirm you agree to the End User Access Agreement for this dashboard.

ODS (organisation) code

When completing the form, you will be asked to provide the ODS code for the organisation you work for. Search for an ODS code using the ODS Portal.

Your full name *

Job role *

Work email address * This cannot be a non-work or shared email address

Organisation name *

Organisation ODS code *

Business justification * Please explain the reason for requiring access, along with brief details about what the data will be used for

Confirm you agree to the terms and conditions for accessing this dashboard *

I agree to the terms and conditions of use for the e-RS dashboard (private version)

A link to the terms and conditions is above the form

Confirm you are in one of the roles listed above *

I confirm I am in one of the roles listed above

Would you like to be contacted about future updates to this dashboard? *