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