Service Requirements YES/NO Essential Services (NHS Trusts only) PAYMENT Expected Annual Contract Value Agreed YES / NO GOVERNANCE AND REGULATORY [ ] Provider’s Nominated Individual Email: [ ] Tel: [ ] Information Governance Lead [ ] Provider’s Email: [ ] Tel: [ ] Caldicott Guardian [ ] Provider’s Email: [ ] Tel: [ ] Senior Information Risk Owner [ ] Provider’s Email: [ ] Tel: [ ] Accountable Emergency [ ] Provider’s Officer Email: [ ] Tel: [ ] Safeguarding Lead [ ] Provider’s Email: [ ] Tel: [ ] Child Sexual Exploitation Lead [ ] Provider’s Email: [ ] Tel: [ ] Mental Capacity and [ ] Provider’s Deprivation of Liberty Lead Email: [ ] Tel: [ ] Freedom To Speak Up [ ] Provider’s Guardian Email: [ ] Tel: [ ] CONTRACT MANAGEMENT Addresses for service of Notices Co-ordinating Commissioner: [ ] Address: [ ] Email: [ ] Commissioner: [ ] Address: [ ] Email: [ ]
Service Requirements Essential Services (NHS Trusts only) YES/NO PAYMENT Expected Annual Contract Value Agreed YES / NO GOVERNANCE AND REGULATORY Provider’s Nominated Individual [ ] Email: [ ] Tel: [ ] Provider’s Information Governance Lead [ ] Email: [ ] Tel: [ ] Provider’s Caldicott Guardian [ ] Email: [ ] Tel: [ ] Provider’s Senior Information Risk Owner [ ] Email: [ ] Tel: [ ] Provider’s Accountable Emergency Officer [ ] Email: [ ] Tel: [ ] Provider’s Safeguarding Lead [ ] Email: [ ] Tel: [ ] Provider’s Child Sexual Exploitation Lead [ ] Email: [ ] Tel: [ ] Provider’s Mental Capacity and Deprivation of Liberty Lead [ ] Email: [ ] Tel: [ ] Provider’s Freedom To Speak Up Guardian [ ] Email: [ ] Tel: [ ] CONTRACT MANAGEMENT Addresses for service of Notices Co-ordinating Commissioner: [ ] Address: [ ] Email: [ ] Commissioner: [ ] Address: [ ] Email: [ ]
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