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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 EditableRead-only | Y | ||||||||||
| 2 | GMC-Registered Surname | LegalSurname | vwPerson | Pre-populate NotRead-editableonly | Y | ||||||||||
| 3 | GMC Number | GMCNumber | vwPerson | Pre-populate NotRead-editableonly | Y | ||||||||||
| 4 | Primary Contact Email Address | EmailAddress | vwPerson | Pre-populate EditableRead-only | Y | Strongly advised to give 'NHS.net' address | |||||||||
| 5 | Deanery / HEE Local Team | LocalOfficeName | vwPerson | Pre-populate Not editableRead-only | Y | ||||||||||
| 6 | Previous Designated Body for Revalidation | DesignatedBody | vwRevalidationEpisodeNot editable | Pre-populate Read-only | Y - if applicable (i.e. only if they have gone through revalidation at the point of ARCP) | ||||||||||
| 7 | Current Revalidation Date | ExpectedRevalidationDate | vwRevalidationEpisodeNot editable | Pre-populate Read-only | Y - if applicable | ||||||||||
| 8 | Date of Previous Revalidation | PreviosusRevalidationDate | vwRevalidationEpisode | Pre-populate NotRead- editableonly | Y - if applicable | ||||||||||
| 9 | Programme / Training Specialty | vwProgrammemembership | ProgrammeNumber | Pre-populate EditableRead-only | Y | ||||||||||
| 10 | Dual Specialty | vwcurrciculummembership | SpecialtyName | Pre-populate EditableRead-only | Y - if applicable | ||||||||||
| Section 2 - WHOLE SCOPE OF PRACTICE (assistance information required) | |||||||||||||||
| 11 | Type of Work | N/A | N/A Free Text Add multiple | Pre-populate Read-only Multiple lines | This should consist of
Alistair Pringle (Unlicensed) - we need to finalise which leave types apply here | ||||||||||
| 12 | Start Date | N/A | N/A | Calendar Picker Add multiplePre-populate Read-only Multiple lines | |||||||||||
| 13 | End Date | N/A | N/A Calendar Picker Add multiple | Pre-populate Read-only Multiple lines | |||||||||||
| 14 | Training Post? | N/A | N/A Options: Y or N | Add multiplePre-populate Read-only Multiple lines | |||||||||||
| 15 | Site Name | N/A | N/A Free Text Add multiple | Pre-populate Read-only Multiple lines | |||||||||||
| 16 | Site Location | N/A | Free Text Add multiplePre-populate Read-only Multiple lines | Guidance text needed | |||||||||||
| Time Out of Training (assistance information required) | |||||||||||||||
17 | Short- and Long-term sickness absence | N/A | N/ANumber counter / entry | Pre-populate Number counter read only | |||||||||||
| 18 | Parental leave (incl Maternity / Paternity leave) | N/A | N/A | Pre-populate Number counter / entryread only | |||||||||||
| 19 | Career breaks within a Programme (OOPC) and non-training placements for experience (OOPE) | N/A | N/A | Pre-populate Number counter / entry read only | |||||||||||
| 20 | Paid / unpaid leave | N/A | N/ANumber | counter / entry Pre-populate Number counter read only | Alistair Pringle (Unlicensed) - can this come from absence data? | ||||||||||
| 21 | Other | N/A | N/A | Number counter / entry | Assistance information required here - see actual form Page 1 | ||||||||||
| 22 | Total | N/A | N/A | Autopopulated count of above fields 16-20 | Confirm this should not include line 21 | ||||||||||
| Section 3 - DECLARATIONS RELATING TO GOOD MEDICAL PRACTICE (assistance information required) | |||||||||||||||
| 23 | 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 | ||||||||||
| 24 | 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 | |||||||||||
| 25 | 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 | |||||||||||
| 26 | 3b) If yes, are you complying with these conditions / undertakings? | N/A | N/A | Yes - go to Q4 No - TBC | Alistair Pringle (Unlicensed) | ||||||||||
| 27 | 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) | |||||||||||||||
| 28 | 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 | |||||||||||
| 29 | 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 | |||||||||||
| 30 | 2a) Declaration Type | N/A | N/A | Smart-search / drop down
| Y - If (2) is yes | ||||||||||
| 31 | 2b) Date of entry into Portfolio | N/A | N/A | Calendar picker | Y - If (2) is yes | ||||||||||
| 32 | 2c) Title / Topic of Reflection/Event | N/A | N/A | Free text | Y - If (2) is yes | ||||||||||
| 33 | 2d) Location of entry in Portfolio | N/A | N/A | Free text | Y - If (2) is yes | ||||||||||
| 34 | 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) | |||||||||||||||
| 35A | I do not have anything new to declare since my last ARCP/RITA/Appraisal | N/A | N/A | selection box | Y - must select either 35A or 35B | ||||||||||
| 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 35A or 35B | ||||||||||
| 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 | |||||||||||
| 36B | Issue Type | N/A | N/A | Drop down:
Add multiple | Y - if 35B is selected | ||||||||||
| 36C | Date of Entry in Portfolio | N/A | N/A | Calendar picker add multiple | Y - if 35B is selected | ||||||||||
| 36D | Title / Topic of Entry | N/A | N/A | Free text Add multiple | Y - if 35B is selected | ||||||||||
| 36E | Location of Entry in Portfolio | N/A | N/A | Free text Add multiple | Y - if 35B is selected | ||||||||||
| 37 | 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 35B selected | ||||||||||
| SECTION 6: COMPLIMENTS (advisory text required) | |||||||||||||||
| 38 | Free text | N/A | N/A | Free text 1000 characters | N | ||||||||||
| SECTION 7: DECLARATION (advisory text required) | |||||||||||||||
| 39 | Declaration statement (see form) | N/A | N/A | Read only | Read only text field | ||||||||||
| 40 | Trainee Signature | N/A | N/A | Name autopopulated based on user logged in
| Y | ||||||||||
| 41 | Date | N/A | N/A | Autopopulated on submission date | Y | ||||||||||