Training Course Registration Form Clinical Coding Trainer Programme This programme is an intensive programme to train in the high quality delivery of NHS clinical coding training compliant with national standards Please ensure you provide ALL required information and documentation when submitting your application. This will ensure that your booking is processed swiftly. The required evidence listed below must be submitted at the same time as your booking form. Failure to submit all of the required documents will result in the application being rejected. As a checklist a copy of the following documents (fully completed and up-to-date) MUST accompany your completed and signed application form. 1. Clinical Coding Trainer Programme CV (which evidences prerequisite criteria 3 to 12) 2. Copy of National Clinical Coding Qualification (UK) Certificate 3. Clinical Coding Standards Refresher course certificate 4. Information Governance Training certificate 5. Full NHS/company purchase order document (please note we are unable to accept applications which only state the PO number) Course information (Please give EXACTLY as found in the Course Schedule) Course Code Title Clinical Coding Trainer Programme Assessment Day Date(s) Price (exc. VAT) Complete as appropriate NHS Employee Non NHS Employee Delegate Information (Block Capitals Please) Title Full Name Job Title Organisation Address Tel Email Fax Special requirements (dietary, access etc) Purchase Order information (Required to confirm booking) Please return this completed form together with a credible, completed supporting CV and copies of the required certificates (see above) to information.standards@hscic.gov.uk.Please confirm the Purchase Order Number on the booking form. Places on the course cannot be fully secured until a full official purchase order document is received. The purchase order should be marked for the attention of the Health & Social Care Information Centre (please see website for full address). Note: Payment is not required at this stage. An invoice will be sent separately after the course providing full payment details. NB: Commercial delegates will also be invoiced for the full cost of the Approved Apprentice Trainer materials when the materials are requested via TRUD after completing and passing the Train the Trainer Course. Please ensure you provide a full company purchase order document/email acceptance of the full costs of the materials (plus VAT) to information.standards@hscic.gov.uk BEFORE requesting the materials via TRUD. This will ensure that your initial TRUD request is processed as swiftly as possible. Please mark your email & purchase order document “FAO NCCS Training”. Thank you. Purchase Order Number (A copy of the PO document is required to book onto course) Invoice Address (Full purchase order (PO) document MUST be provided to process this booking and to secure a place on the course. If applicable, please provide NHS SBS contact details) Line Manager must complete ALL the questions below: Line Manager Authorisation On behalf of the above organisation, I: i. Confirm I have read the Clinical Coding Trainer Programme Handbook and am fully aware of the pre and post course requirements for this programme. ii. Confirm that the delegate meets criteria 1-15 as listed in the Clinical Coding Trainer Programme Handbook. iii. Authorise for the delegate to be released to attend all elements of the programme (i.e. the Clinical Coding Trainer Programme Assessment Day, the Certificate in Education & Training module in Coventry (5 days + completion of the 5-7 hour online course – the Theoretical Basis of Learning) and the 5 day Train the Trainer module in Leeds or London (subject to passing the Assessment Day), the mandatory annual Clinical Coding Trainer Forum, and the mandatory three-yearly Clinical Coding Trainer Refresher Course. iv. Confirm that full funding will be available for the delegate to attend all elements of the programme, including that for the mandatory ongoing delivery skills assessments, and including residential accommodation. v. Confirm that part of the job of the above delegate is, or will be, part of an ongoing programme of clinical coding training delivery within our organisation. vi. Confirm that the necessary resources in relation to equipment (including access to Microsoft PowerPoint compatible with Office 2007), preparation time and admin support will be available to the delegate to assist in the delivery of a minimum of 21 clinical coding training days per year. vii. Confirm that the delegate and myself as their line manager will complete the necessary sections of the online Approved Clinical Coding Trainer Log Book on an annual basis for review by the Clinical Classifications Service. Failure to comply with this requirement will result in Approved Trainer status being removed. I confirm that I agree to all course terms and conditions outlined on the Clinical Classifications website and on page four of this form (Tick the relevant box) Yes No Manager’s Name Job Title Signature Date Delegate must complete ALL the questions below: Delegate Declaration On applying for this programme, I confirm i. ii. iii. iv. v. vi. vii. viii. I have read the Clinical Coding Trainer Programme Handbook and am aware of the pre and post course requirements for attending this programme I meet criteria 1-15 as listed in Clinical Coding Trainer Programme Handbook. My commitment to attend all elements of the programme (i.e. the Clinical Coding Trainer Programme Assessment Day, the Certificate in Education & Training module in Coventry (5 days + completion of the 5-7 hour online course – the Theoretical Basis of Learning) and the 5 day Train the Trainer module in Leeds or London (subject to passing the Assessment Day), the mandatory annual Clinical Coding Trainer Forum, the mandatory three-yearly Clinical Coding Trainer Refresher Course, and the mandatory ongoing delivery skills assessments. That part of my job is, or will be, part of an ongoing programme of clinical coding training within our organisation. My commitment to deliver a minimum of 21 clinical coding training delivery days per year. (This can include clinical coding awareness sessions). I have access to Microsoft PowerPoint compatible with Office 2007 on my PC / laptop. I will complete the appropriate sections of the on line Approved Clinical Coding Trainer Log Book on an annual basis for review by the Clinical Classifications Service. Failure to comply with this requirement will result in removal from the list of Approved Clinical Coding Trainers. My commitment to maintaining my own continued professional development. I confirm that I agree to all course terms and conditions outlined on the Clinical Classifications website and on page four of this form (Tick the relevant box) Yes No Delegate’s Name Job Title Signature Date REGISTRATION TERMS AND CONDITIONS The Fees: The quoted fees for courses include documentation, unless otherwise stated, and refreshments at each course break. Cancellations: A cancellation charge of 100% of the fee will be levied for all cancellations made 28 days or less before the course and cancellations within 40 days will be charged 50%. No charge will be made for a change of delegate, providing he / she complies with the course criteria. For changes made shortly before a course we cannot guarantee the delegate will receive the course documentation in time. If you wish to make a cancellation, please email information.standards@hscic.gov.uk (marked FAO NCCS Training) to notify the Training Co-ordinator. Accommodation: Delegates attending courses are responsible for their own accommodation and travel arrangements and resulting costs. Delegates will be provided with a map and a list of accommodation known to us in the area. The Clinical Classifications Service takes no responsibility for any accommodation booking made by delegates. Copyright: The copyright of all course material and publicity material is invested in the Health & Social Care Information Centre, except where stated and may not be reproduced in whole or in part, recorded, loaned, broadcast, stored in a retrieval system or displayed publicly without prior permission. Course Content: 1. Course content for public courses will be as stated in the current Clinical Classifications Service course details. Course content for other courses will be as described in published course publicity. However, the Clinical Classifications Service reserves the right to amend the course content for public courses without notice. 2. Course content for on-site courses will normally be as described in the current Clinical Classifications Service training services course details, except where otherwise agreed in writing with the client. Course Dates and Venues: 1. The Clinical Classifications Service reserves the right to change any course dates as published in its schedule of courses. 2. The Clinical Classifications Service reserves the right to cancel an individual confirmed booking by sending written notice to the client not less than five days prior to the start of the course. 3. If training services is unable to start or complete a scheduled course because of illness, or for any other cause beyond our control, and where no notice is given, we shall attempt to remedy such situations. But will not be liable for any consequential loss or expenses incurred by the client. 4. If the Clinical Classifications Service is obliged to change advertised course venues for reasons beyond its control, we shall provide as much notice as possible, but will not be liable for any consequential loss or expenses incurred by the client. Data Protection: Details of all client registrations are maintained on a database. These details may be used to advise our clients of other Clinical Classifications Service training products and services, but are not made available to any other organisations for any purposes. If you do not wish your details to be held in this way, please advise us. If you wish to see a copy of the details we hold about you as an individual, these can be provided on request subject to verification of identity. On Site Courses: The client is responsible for providing adequate facilities for on-site courses. Should a trainer or facilitator feel that requirements are not met (for example, with regards to Health and Safety) the Clinical Classifications Service reserves the right to terminate an event and recover costs. Please return to Clinical Classifications Service Training, c/o Information Standards Helpdesk, Hexagon House, Pynes Hill, Exeter EX2 5SE Email: information.standards@hscic.gov.uk