Summary Care Record Opt Out Form

Unless you OPT OUT, your basic details (Name, Contact Details, Medication & Allergies) will be stored on a national database and be accessible to other health professionals. Your permission to view this information will be requested where possible.

If you DO NOT want a Summary Care Record please fill out the form below or downlaod a copy here and return to Reception.

1Summary Care Record Opt Out Form

If you are filling out this form on behalf of another person or a child, their GP practce will consider this request.

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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