Summary Care Record Opt Out

During these difficult times the Practice continues to encourage all Patients to seek our help when required. We are however facing a high level of demand which means that there may be a delay in responding to your request, all requests deemed by a Doctor to be urgent will be dealt with immediately. Thank you for your patience and understanding.

Your Summary Care Record contains important information from the record held by your GP practice and includes details of any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced. Your Summary Care Record also includes your name, address, date of birth and your unique NHS Number to help identify you correctly. As part of a mandatory national programme each GP Practice had to make a summary care record for each patient by March 2015 (unless the patient has already opted out). You can choose to opt out of this scheme at any time.

If you wish to opt out of the Summary Care Record scheme please complete the opt out form below.

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Please select which site you are registered at: *

Section A

If you are filling this form on behalf of another person or child please ensure you fill their details in section A and your details in section B.

Full Name: *

Address (including postcode):

Phone Number:

NHS number (if known):

Section B

If you are filling this form on behalf of another person or child please ensure you fill their details in section A and your details in section B.

Your name:

Electronic Signiture:

Relationship to patient:

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