Patient registration and health questionnaire February 2024

Patient registration and health questionnaire February 2024

New patient registration form completed with Access to records sections added along with NHS app details to be forwarded to patients following registration. 

Patient Agreement

Thank you for your request to join our surgery. If possible, please bring proof of your address and photographic identification, if you have any, with you when you return your registration forms. Please ensure you have completed and signed all forms as this may delay your registration with the practice. 

 

Patient Agreement 

 

  1. I agree to request my medication at least 2 working days before I require it. I also agree to make my request either in person, post, online or via the dedicated prescription line which is open Monday – Friday 11 am till 12 pm.  

 

  1. I agree that the surgery has a ZERO TOLERANCE of abuse towards staff. I agree not to behave in an abusive, threatening or otherwise aggressive manner with any member of practice staff. 

 

  1. I agree to attend my appointments on time. I acknowledge that if I arrive late for my appointment, I may be asked to re-book. When booking an appointment reception staff will ask for a brief reason this is to ensure the appointment is booked with the most appropriate clinician. Please be aware that all staff have signed a confidentiality agreement. 

 

  1. The practice uses a text messaging service for appointment reminders and other health related matters. I acknowledge that appointment reminders are an additional service and that they may not take place on all occasions. The responsibility of attending or cancelling appointments rests with me. I can cancel the text message facility at any time. 

 

  1. I shall only request a home visit from the practice under circumstances where I cannot physically attend. I understand that these requests, wherever possible, will be made before 11am. 

 

  1. A chaperone is available for any consultation at any stage. This can be requested via the reception staff or any clinical staff member. I understand that the clinician also has the right to request a chaperone at any point. 


































































Data Sharing

DATA SHARING 

You need to let us know if you wish to opt out of any of the services below: 

 

Summary Care Record 

 

If you are registered with a GP practice in England, you will already have a Summary Care Record (SCR), unless you have previously chosen not to have one. It will contain key information about the medicines you are taking, allergies you suffer from and any adverse reactions to medicines you have had in the past. 

  

You have a choice 

You have the choice of what information you would like to share and with whom. Authorised healthcare staff can only view your SCR with your permission. The information shared will solely be used for the benefit of your care. 

 

Your options are outlined below. 

 

  • Express your consent for medication allergies and adverse reactions only (Core SCR).  

You wish to share information about medication, allergies and adverse reactions only. 

 

  • Express consent for medication, allergies, adverse reactions and additional information (SCR with additional information) 

You wish to share information about medication, allergies, adverse reactions and further medical information which includes: your illnesses and health problems, operations and vaccinations you have had in the past, how you would like to be treated (such as where you would prefer to receive care), what support you might need and who should be contacted for more information about you. 

 

  • Express dissent for Summary Care Record (opt out). 

Select this option if you DO NOT want any information shared with other healthcare professionals involved in your care. 

 

If you choose not to complete this consent form, a core Summary Care Record (SCR) will be created for you, which will contain only medications, allergies and adverse reactions. You are free to change your decision at any time by informing your GP practice. 




Access to GP ONLINE SERVICES

In order for access to be given your identity must be verified, please provide one of the following for verification: 

  • - Passport 

  • - Photo Driving Licence  

  • - National Identity Card 


National Opt Out Facility

You can choose whether your confidential patient information is used for research and planning. 

Who can use your confidential patient information for research and planning? 

It is used by the NHS, local authorities, university and hospital researchers, medical colleges and pharmaceutical companies researching new treatments.  

Making your data opt-out choice 

You can choose to opt out of sharing your confidential patient information for research and planning. There may still be times when your confidential patient information is used: for example, during an epidemic where there might be a risk to you or to other people’s health. You can also still consent to take part in a specific research project. 

Will choosing this opt-out affect your care and treatment? 

No, your confidential patient information will still be used for your individual care. Choosing to opt out will not affect your care and treatment. You will still be invited for screening services, such as screenings for bowel cancer. 

What should you do next? 

You do not need to do anything if you are happy about how your confidential patient information is used. If you do not want your confidential patient information to be used for research and planning, you can choose to opt out securely online or through a telephone service. 

You can change your choice at any time. To find out more or to make your choice visit nhs.uk/your-nhs-data-matters or call 0300 303 5678. Patients who have registered for the NHS App using NHS login can set a national data opt-out using the app. 

Application for Online Access to Your Medical Record

Important Information – Please read before returning or submitting the Online Access Form - Identification will need to be seen by a staff member

 

If you wish, you can now use the internet/mobile phone to book appointments with a GP, request repeat prescriptions for any medications you take regularly, look at your test results, immunisations and medical records all online. Also, you can still call the surgery for any queries regarding the above services.  It’s your choice. 

 

It will be your responsibility to keep your login details and password safe and secure.  If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately. 

 

If for any reason you cannot do this, we recommend that you contact the practice so that they can remove your online access until you are able to reset your password. 

 

If you print out any information from your records, it will be your responsibility to keep this safe and secure.  If you are at all worried about keeping printed copies safe and secure, we recommend that you do not make copies at all.  

 

Before you apply for online access to your record, there are some other things to consider. 

 

Although the chances of any of the following happening are very small, you will be asked if you have read and understood the following before you are given login details from our Staff Member. If you wish to have access to your Online Medical Record please ask at Reception for a Form to complete. 

 

 
 
 
 
 
 

Forgotten history  

There may be something you have forgotten about in your record that you might find upsetting.  
 
 
 
 
 

Abnormal results or bad news   

If your GP has given you access to test results or letters, you may see something that you find upsetting to you. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them.  
 
 
 
 
 

Choosing to share your information with someone  

It’s up to you whether or not you share your information with others – perhaps family members or carers. It’s your choice, but also your responsibility to keep the information safe and secure. 
 
 
 
 
 

Coercion  

If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time. 
 
 
 
 
 

Misunderstanding Medical Information  

Your medical record is designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information within your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification, please contact the surgery for a clearer explanation.  
 
 
 
 
 

Information about someone else  

If you spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible. 

 

By completing this section you are confirming the following:

I will be responsible for the security of the information that I see or download.

If I choose to share my information with anyone else, this is at my own risk.

I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement.

If I see information in my record that it not about me, or is inaccurate I will log out immediately and contact the practice as soon as possible.

 

 

 

 

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Page last reviewed: 23 February 2024
Page created: 01 February 2022