IM1 Bulk Extract Request
Organisation and Product Information
Supplier organisation name | |
Commercial person(s) contact details | |
Technical person(s) contact details | |
Data Protection Officer contact details | |
Clinical Safety Officer contact details |
Clinical Data Areas Required
Allergies | |
AllergyIntolerance | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Medication and Medical Devices | |
Medication | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
MedicationStatement | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
MedicationRequest | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Immunisations | |
Immunization | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Observation - Blood Pressure | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Observation - Uncategorised data | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Consultations | |
Consultation | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Encounter | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Investigations | |
DiagnosticReport | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Specimen | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Observation - Test Result | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Observation | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
ProcedureRequest | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Problems | |
Problems | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Referrals | |
ReferralRequest | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |
Diary Entries | |
Diary Entry | Please outline the justification for including this data set in the extract. If the data set isn’t required, then specify “n/a”. |