Summary Care Record

Summary Care Record

The Summary care record is an electronic summary of basic information such as allergies and regular medicines so that in an emergency, doctors and nurses who have secure access can make the best care decisions for patients.

Your information will be extracted from practices such as ours and held on a central NHS databases.

With the new system, people who are treating you will be able to access those parts of your record that they are allowed to see whenever they need it to provide you with care.

A record of everyone who looks at your summary care record is kept. Notification will be sent to a nominated member of staff if your record is accessed in an unexpected setting, for example if a clinician who doesn’t usually treat you accesses your information. If it is found that access was unreasonable, we will let you know.

What do I need to do?

If you are happy to have a summary care record, you do not need to do anything. If you would like to opt out please complete the form below.

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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.

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Layout

Email *

Phone Number

Date Of Birth *

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.

Name

First

Middle

Last

Electronic Signature:

Relationship to patient:

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