Public Benefit and Privacy Panel for Health and Social Care PBPP Amendment Request Form to be completed for changes to an approved – PBPP application Application Control - please complete all sections below Application Coordinator Application Number Approval date Applicant name Applicant address Proposal name Amendment submission date e.g. The aims and objectives of the proposal have Summary of amendment changed to include a look at prescribing patterns of (including justification cardiovascular drugs amongst the elderly in addition /explanation of changes) to cardiovascular admissions to cover both secondary and primary care. Original Approval letter Supporting Documents Updated application with version number (please ensure that the IG certificates (if applicable) original approval letter is (please detail) attached with all submissions)
Public Benefit and Privacy Panel for Health and Social Care PBPP Amendment Request Form – to be completed for changes to an approved PBPP application Application Control - please complete all sections below Application Coordinator Application Number Approval date Applicant name Applicant address Proposal name Amendment submission date Summary of amendment (including justification /explanation of changes) e.g. The aims and objectives of the proposal have changed to include a look at prescribing patterns of cardiovascular drugs amongst the elderly in addition to cardiovascular admissions to cover both secondary and primary care. Supporting Documents (please ensure that the original approval letter is attached with all submissions) Original Approval letter Updated application with version number IG certificates (if applicable) (please detail)
PBPP-Amendment-Request-form-v1.docx