Business Intelligence

Report Request Form

Name of requester: *

Email of requester: *

Name and email of any additional people the data needs to be sent to:

What is the reason for this request (NOT FOR REQUESTING DASHBOARD ACCESS)? (reason/purpose/benefits)* *

What are your requirements? (facts/goals/information) * *

How are you going to use this information? (methods/implementation/activity)? * *

If known, how is this information recorded and on what system? *

Please tell us how you would like to view the information *

Patient Level details BUT not identifiable (dataset) Patient identifiable details (dataset) Summary Tables Charts/Graphs Other

Please tell us what date parameters you require (time period)? *

Current Reporting Year (Starts 1st April) 2 years Last 12 months Other

Please enter the date of when you would like the request completed by: We will be in touch to confirm expected completion date and will keep you informed should anything change: *

To report an issue with a form email us at
web@ecchcic.nhs.uk