Summary Care Record Opt-Out Form

OPT-OUT FORM
Request for my clinical information to be withheld from the Summary Care Record.

If you DO NOT want a Summary Care Record please fill out the form below.

Summary Care Record Opt-Out Form

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

Please ensure you fill out their details in the section above and your details in the section below.

What does it mean if I DO NOT have a Summary Care Record?

NHS healthcare staff caring for you may not be aware of your current medications, allergies you suffer from and any bad reactions to medicines you have had, in order to treat you safely in an emergency.

Your records will stay as they are now with information being shared by letter, email, fax or phone.

If you have any questions, or if you want to discuss your choices, please contact your GP practice.


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. 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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