Note: If the request is for validation of the draft report of a systems analysis investigation please confirm that the factual accuracy check has been carried out on the draft report Support Type 3: To participate as member of the investigation/review Specify team* on the limited availability of clinical/technical experts to participate as members of Investigation/Review Teams; requests for input should be as far as reasonably practical be limited to (1) and (2) above Section 4: Details of Investigation/Look Back Review Team List the members of the Investigation/Look Back Review Team and their areas of responsibility: Name Responsibility Section 5: Case Background and Goals Outline general background and brief chronology of the case Purpose of investigation/look back As per of reference (TOR) review Are the terms of reference attached for Yes/No the investigation/look back review? Section 6: Review Approach (Methodology) Yes/No A System Analysis Investigation A Review of multiple Yes/No If multiple cases, indicate the number of cases under review Other (please specify) Section 7: Availability of Records and Information Outline the range of material to be made available to the clinician(s) providing the specialist support during the investigation: Outline how the nominated specialist Review files on site, files to be couriered to clinical expert etc clinician will be able access this information Section 8: Timescale for External Input Expected start date Expected end date
Note: If the request is for validation of the draft report of a systems analysis investigation please confirm that the factual accuracy check has been carried out on the draft report Support Type 3: To participate as member of the investigation/review team* on the limited availability of clinical/technical experts to participate as members of Investigation/Review Teams; requests for input should be as far as reasonably practical be limited to (1) and (2) above Specify Section 4: Details of Investigation/Look Back Review Team List the members of the Investigation/Look Back Review Team and their areas of responsibility: Name Responsibility Section 5: Case Background and Goals Outline general background and brief chronology of the case Purpose of investigation/look back review As per of reference (TOR) Are the terms of reference attached for the investigation/look back review? Yes/No Section 6: Review Approach (Methodology) A System Analysis Investigation Yes/No A Review of multiple If multiple cases, indicate the number of cases under review Yes/No Other (please specify) Section 7: Availability of Records and Information Outline the range of material to be made available to the clinician(s) providing the specialist support during the investigation: Outline how the nominated specialist clinician will be able access this information Review files on site, files to be couriered to clinical expert etc Section 8: Timescale for External Input Expected start date Expected end date
request-for-specialist-support-for-reviews-fpgtb-application-form.docx