Please read the Usage Policy before completing this registration form.

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Personal Details

First Name:

Please enter your first name.

Surname:

Please enter your surname.

Department:

Dermatology ED (Emergency Department) GU Clinic Orthopaedic Paediatrics Plastics Podology Surgical Tissue Viability -- Select Department --
If your department is not listed please contact the SCIT Administrator.

Job Title:

Please supply your job title.

Govt. Mail

Please enter your NHS email address.

Domain User ID:

Please enter your domain User ID

Please supply your domain user ID (e.g. smithjo123)

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Purpose of Recordings

Application & Operation:

Describe the clinical need for the app - please include why, when and where it will be used, and the average number of patient episodes per month.

Please complete this information.

Recording Devices

The SCIT app is only available to users with MATER DEI HOSPITAL, MALTA-owned devices. More information on approved devices can be found here

Make / model:

Please complete this information.

Mobile Phone Number:

Please enter the cost centre (or '-' if not known).

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Accountability and Declaration

Lead Clinician / Head of Service providing permissions for user to make recordings of patients:

Please supply your line manager's name

Describe the mechanism for reporting adverse incidents in relation to the device and app:

Please supply details.

Initial Password:

Please enter your new password.
Password needs to be 8 characters or greater,
and contain at least one number, one capital and one lowercase letter.
Please provide a password you would like to use when your account is approved . Your password needs to be:

8 characters or greater
Contain at least one number, one capital and one lowercase letter.

Verify Password:

Sorry, but your passwords do not match

By ticking this box, you confirm that you have read and understood the Usage Policy and agree to the terms and conditions within.

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Apply for Access