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Assumptions
- All fields are mandatory
- Specified fields should also be editable, should the Trainee need to make changes to what is held in the system - these are currently captured on the
- Appropriate field assistance should be displayed
- Trainee photograph from the original form is not needed
- All help text should be displayed as is contained within the form
- This is only displayed to medical trainees
| Order | Field name | DR field | Reference Table | Example value | Other fields available in DR | Type (free text, drop down, check box) & Interaction (autopopulate etc) | Mandatory (Y/N) | Validation / Error Messaging | Filter (Y/N) | Search (Y/N) | Sort (Y/N) | List (S) / Detail (D) | Notes | Delete field | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Form R - Part B | |||||||||||||||
| Section 1 - DOCTORS DETAILS (assistance information required) | |||||||||||||||
| 1 | Forename | Forenames | vwPerson | Pre-populate Editable | Y | ||||||||||
| 2 | GMC-Registered Surname | LegalSurname | vwPerson | Pre-populate Not-editable | Y | ||||||||||
| 3 | GMC Number | GMCNumber | vwPerson | Pre-populate Not-editable | Y | ||||||||||
| 4 | Primary Contact Email Address | EmailAddress | vwPerson | Pre-populate Editable | Y | Strongly advised to give 'NHS.net' address | |||||||||
| 5 | Deanery / HEE Local Team | LocalOfficeName | vwPerson | Pre-populate Not editable | Y | ||||||||||
| 6 | Previous Designated Body for Revalidation | DesignatedBody | vwRevalidationEpisode | Not editable | Y - if applicable | ||||||||||
| 7 | Current Revalidation Date | ExpectedRevalidationDate | vwRevalidationEpisode | Not editable | Y | ||||||||||
| 8 | Date of Previous Revalidation | PreviosusRevalidationDate | vwRevalidationEpisode | Not-editable | Y - if applicable | ||||||||||
| 89 | Programme / Training Specialty | vwProgrammemembership | ProgrammeNumber | Pre-populate Editable | Y | ||||||||||
| 910 | Dual Specialty | vwcurrciculummembership | SpecialtyName | Pre-populate Editable | Y | ||||||||||
| Section 2 - WHOLE SCOPE OF PRACTICE (assistance information required) | |||||||||||||||
| 1011 | Type of Work | N/A | N/A | Free Text Add multiple | |||||||||||
| 1112 | Start Date | N/A | N/A | Calendar Picker Add multiple | |||||||||||
| 1213 | End Date | N/A | N/A | Calendar Picker Add multiple | |||||||||||
| 1314 | Training Post? | N/A | N/A | Options: Y or N Add multiple | |||||||||||
| 1415 | Site Name | N/A | N/A | Free Text Add multiple | |||||||||||
| 1516 | Site Location | N/A | Free Text Add multiple | Guidance text needed | |||||||||||
| Time Out of Training (assistance information required) | |||||||||||||||
1617 | Short- and Long-term sickness absence | N/A | N/A | Number counter / entry | |||||||||||
| 1718 | Parental leave (incl Maternity / Paternity leave) | N/A | N/A | Number counter / entry | |||||||||||
| 1819 | Career breaks within a Programme (OOPC) and non-training placements for experience (OOPE) | N/A | N/A | Number counter / entry | |||||||||||
| 1920 | Paid / unpaid leave | N/A | N/A | Number counter / entry | |||||||||||
| 2021 | Other | N/A | N/A | Number counter / entry | Assistance information required here - see actual form Page 1 | ||||||||||
| 2122 | Total | N/A | N/A | Autopopulated count of above fields 16-20 | |||||||||||
| Section 3 - DECLARATIONS RELATING TO GOOD MEDICAL PRACTICE (assistance information required) | |||||||||||||||
| 2223 | 1) I declare that I accept the professional obligations paced on me in Good Medical Practice in relation to honesty and integrity. | N/A | N/A | Selection box Y / N | Guidance information required here | ||||||||||
| 2324 | 2) I declare that I accept the professional obligations placed on me in Good Medical Practice about my personal health | N/A | N/A | Selection box Y / N | |||||||||||
| 2425 | 3a) Do you have any GMC conditions, warnings or undertakings placed on you by the GMC, employing Trust or other organisation? | N/A | N/A | Selection box Yes - go to Q3b No - go to Q4 | |||||||||||
| 2526 | 3b) If yes, are you complying with these conditions / undertakings? | N/A | N/A | Yes - go to Q4 No - TBC | |||||||||||
| 2627 | 4) Health Statement | N/A | N/A | Free text 500 words | N | Guidance text needed here | |||||||||
| SECTION 4 - UPDATE TO PREVIOUS FPRM R PART B (guidance/warning info needed) | |||||||||||||||
| 2728 | 1) If you did not declare significant events, complaints, or other investigations on your previous Form R Part B, check this box | N/A | N/A | Check box Go to Section 5 | |||||||||||
| 2829 | 2) If any previously declared significant events, complaints, or other investigations have been resolved since your last ARCP/RITA/Appraisal, you are required to have written a reflection on these in your Portfolio | N/A | N/A | Selection: Y/N Add multiple | |||||||||||
| 2930 | 2a) Declaration Type | N/A | N/A | Smart-search / drop down
| Y - If (2) is yes | ||||||||||
| 3031 | 2b) Date of entry into Portfolio | N/A | N/A | Calendar picker | Y - If (2) is yes | ||||||||||
| 3132 | 2c) Title / Topic of Reflection/Event | N/A | N/A | Free text | Y - If (2) is yes | ||||||||||
| 3233 | 2d) Location of entry in Portfolio | N/A | N/A | Free text | Y - If (2) is yes | ||||||||||
| 3334 | 3) Unresolved detail | N/A | N/A | Free text | N | Guidance text required | |||||||||
| Section 5: NEW DECLARATION SINCE YOUR PREVIOUS FORM R PART B (guidance/warning info needed) | |||||||||||||||
| 34A35A | I do not have anything new to declare since my last ARCP/RITA/Appraisal | N/A | N/A | selection box | Y - must select either 34A 35A or 34B35B34B | ||||||||||
| 35B | I have been involved in significant events/complaints/other investigations since my last ARCP/RITA/Appraisal | N/A | N/A | selection box | Y - must select either 34A 35A or 34B35B35A | ||||||||||
| 36A | If you know of any resolved significant events/complaints/other investigations since your last ARCP/RITA/Appraisal, you are required to have written a reflection on these in your Portfolio. Please identify where in your Portfolio the reflection(s) can be found | N/A | N/A | Read only text field | |||||||||||
| 35B36B | Issue Type | N/A | N/A | Drop down:
Add multiple | Y - if 34B 35B is selected | ||||||||||
| 35C36C | Date of Entry in Portfolio | N/A | N/A | Calendar picker add multiple | Y - if 34B if 35B is selected | ||||||||||
| 35D36D | Title / Topic of Entry | N/A | N/A | Free text Add multiple | Y - if 34B if 35B is selected | ||||||||||
| 35E36E | Location of Entry in Portfolio | N/A | N/A | Free text Add multiple | Y - if 34B if 35B is selected | ||||||||||
| 3637 | If you know of any unresolved significant events/complaints/other investigations since your last ARCP/RITA/Appraisal, please provide below a brief summary, including where you were working, the date of the event and your reflection where appropriate. If known, please identify what investigations are pending relating to the event and which organisation is undertaking the investigation. | N/A | N/A | FREE TEXT 500 characters | Y - if 34 35B selected | ||||||||||
| SECTION 6: COMPLIMENTS (advisory text required) | |||||||||||||||
| 3738 | Free text | N/A | N/A | Free text 1000 characters | N | ||||||||||
| SECTION 7: DECLARATION (advisory text required) | |||||||||||||||
| 3839 | Declaration statement (see form) | N/A | N/A | Read only | Read only text field | ||||||||||
| 3940 | Trainee Signature | N/A | N/A | Name autopopulated based on user logged in
| Y | ||||||||||
| 4041 | Date | N/A | N/A | Autopopulated on submission date | Y | ||||||||||