CRIS Project Application Form

1. Are you applying to use CRIS for research, audit, service development / evaluation or quality improvement?

2a. First Name

2b. Last Name

2c. Job Title

2d. Department

2e. Organisation

2f. Applicant’s ORCID ( https://orcid.org/register )

2g. Preferred email address (if possible, please provide an NHS or university email address)

3. Do you have a substantive or honorary contract with SLaM?

3a. Other SLaM Affiliation Details

4. Project Title

5. Lay Summary: Please provide just one sentence summarising the reasoning behind the project, and just one sentence describing what the project will do

6. Objectives of the analysis

7. Rationale for the analysis (i.e. anticipated benefits / useful knowledge will arise from the results)

8. Types of variables you envisage using to define groups

9. Types of variables you envisage needing as outputs

10. Are there any variables / combinations of variables which might identify individuals on the database? If yes: what steps will be taken to avoid de-anonymisation?

11a. Research Ethics Committee approval number (REC approval number).

11b. Date of REC approval

11c. REC Expiry Date

11d. IRAS ID

11e. SLaM Research and Development (R&D) reference number

11f. Date of SLaM R&D approval

11g. Quote statement which explicitly states that your project is covered to approach clients who have given consent to be approached for recruitment purposes

12a. Will your project require linking CRIS data to one of the external datasets held by the SLaM secure Clinical Data Linkage Service (CDLS), e.g. HES (acute hospital admissions, outpatient, and A&E attendance), cause of death data, etc.? If yes, please complete Q12a. If no, please continue to Q13 -

12b. Please state which dataset your project will require linkage to (i.e. HES, Mortality, etc.)

13. Names of anyone else who will be involved in CRIS use for this project (anybody accessing CRIS data must have a contract with SLaM)

14. Please provide details of your supervisor. Please note, we would like the details of the supervisor for the project you’ve detailed in this application - this may not necessarily be your line manager. Are you applying as the supervisor?

14a. Please indicate your level of clinical and/or academic seniority

14b. Supervisor’s First Name

14c. Supervisor’s Last Name

14d. Supervisor’s Job Title

14e. Supervisor’s Organisation

14f. Supervisor’s Email Address

14g. Supervisor’s ORCID

14h. Type of SLaM Contract

14I. Other SLaM Affiliation Please State:

15. All CRIS projects must have a least one collaborator who is an employee of King’s Health Partners (KHP), i.e. King’s College London University, South London and Maudsley NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust

15a. Please provide the name and organisation of the person named on this application who will act as the KHP collaborator for the project.

16. How long do you envisage requiring use of CRIS for this project?

17a. For audits, service evaluations/ developments, and quality improvement projects, please complete Q17 a-c. Please confirm the project has received appropriate SLaM Clinical Governance approval and email the approval to the CRIS administrator

17b. State the Directorate responsible for this approval

17c. Give the title of the approved project if different from above

18. What is the output envisaged to directly arise from this analysis (peer reviewed publication/ pilot study)? If you intend to publish the output, please give an indication of where you are intending to publish

19. Is it likely that texts from CRIS will be quoted in the publications?

20. Does this application relate to a study forming all or part of an MSc dissertation?

21. Who is the main funder for this application?

21b. If Other – please state

21a. Please provide details of the funder including name, the approximate cost and grant reference number.

22. Do you envisage any commercially relevant intellectual property as an output from this project?

23. Use of CRIS requires adherence to the CRIS Security Model, available to view Here, Please select 'Yes' to confirm that you have read and understood these requirements.

By submitting this project application, you agree to treat CRIS data confidentially and in adherence to the guidelines stated above. You confirm to have the necessary honorary or substantive contract with SLAM to be authorised to access CRIS. Your searches will be audited to ensure that all searches are within the remit of the project you specify in this application form. Any searches performed outside the remit of the application form will be queried with the user and where found in breach of CRIS terms and conditions, CRIS access may be withdrawn subject to discussions with the CRIS Oversight Committee. You agree and confirm that this project has the relevant audit approvals or if a research project has an official research supervisor.

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CRIS Project Application Form