Smartcard Access Request Form
Please use this form if you have a NHS smartcard already issued in your name but and are unable to get a sponsor to complete a request via Care Identity Service (CIS) portal.
1. Full Name (please give your GPHC registered name) *
2. Confirm that you live in Bolton *
If you live in other areas of Greater Manchester please complete the form on the GM LPC website https://psnc.org.uk/greater-manchester-lpc/resources/smartcard-access/. If you live outside of Greater Manchester you will need to contact the local RA in the area that you live in. Details can be obtained here: http://bitly.ws/6cXT
3. Home Postcode - to match documents on ID check appointment: *
4. Preferred contact telephone number *
5. Email address *
6. Smartcard Number *
7. GPHC number *
8. Do you need Locum (FFFFF code) assigned? *
9. If no, please provide F code: *
10. Do you need SCR access? *
If Yes, please ensure you have completed the SCR e-assessment and given access to the RA to view completion
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