Interventional procedures notification form

Interventional procedures notification form
Tell us about an interventional procedure you think should be assessed by NICE.

About our notification process.

Fields marked with an asterisk (*) are mandatory.
Your details
Name*

First nameLast name
Organisation
Email*
example@example.com
Role?*
Other role (please specify)
Information on the procedure
Type

NewExisting
Name of procedure*
Indication for procedure. *

If more than one, please complete a separate form.0/2500
Briefly describe the procedure*

Please cite any published papers, abstracts or trial protocol.0/2500
Device and manufacturer name (if the procedure involves a device).

0/2500
Information on comparator procedures.

0/2500

Notify new procedures
A new procedure must be a:
- Surgical procedure - making a cut or a hole to gain access to the inside of a patient's body.
- Procedure accessing the body cavity without cutting.
- Procedure using electromagnetic radiation. For example x-rays, lasers.
It must also:
- Be available within the NHS or independent sector, or be about to be used for the first time, outside formal research.
- Not yet be considered standard clinical practice.
Note: While guidance is in development, clinicians wishing to carry out the procedure, and their trusts, should ensure that special arrangements are in place for consent, governance, audit and research.
Where is the procedure being done?

To your knowledge, is this procedure being done:
In the NHS?*

YesNoDon't know
Please give details.
In the private sector?*

YesNoDon't know
Please give details.
In a research setting?*

YesNoDon't know
Please give details.
If you do not know that the procedure is currently in use in the UK, do you know of any clinicians or hospitals interested in using it?
Additional information
Any other comments.
Please declare any conflicts of interest.
Supporting information.

Word, Excel, PDF.
Cancelof
Upload any published data and evidence in support of your submission.

Please include:
- your name
- the name of the procedure, or the name and number of our existing guidance you think should be reviewed
- details of any confidential information.
We’ll use the information you provide on this form to contact you about the outcome of your notification. If the notified procedure falls within the remit of the programme we’ll notify you when consultation starts.

For more information about how we use your data, view our privacy notice.

Notify guidance for review
Let us know about safety concerns and new information you have about our existing interventional procedures guidance.

Tell us about new evidence which you think might help the advisory committee reach a different decision.
Where is the procedure being done?

To your knowledge, is this procedure being done:
In the NHS?*

YesNoDon't know
Please give details.
In a research setting?*

YesNoDon't know
Please give details.
In the private sector?*

YesNoDon't know
Please give details.
If you do not know that the procedure is currently in use in the UK, do you know of any clinicians or hospitals interested in using it?
Additional information
Any other comments.
Please declare any conflicts of interest.
Supporting information.

Word, Excel, PDF.
Cancelof
Upload any published data and evidence in support of your submission.

Please include:
- your name
- the name of the procedure, or the name and number of our existing guidance you think should be reviewed
- details of any confidential information.
We’ll use the information you provide on this form to contact you about the outcome of your notification. If the notified procedure falls within the remit of the programme we’ll notify you when consultation starts.

For more information about how we use your data, view our privacy notice.
Should be Empty:

Interventional procedures notification form

Your details

Information on the procedure

Notify new procedures

Where is the procedure being done?

Additional information

Notify guidance for review

Where is the procedure being done?

Additional information