Record Sharing Opt-Out Form - Firs House Surgery

Sharing Health Record Opt-Out Form (Type 1 OPT-OUT)

The data held in your GP medical records is shared with other healthcare professionals for the purposes of your individual care. It is also shared with other organisations to support health and care planning and research. If you do not want your personally identifiable patient data to be shared outside of your GP practice for purposes except your own care, you can register an opt-out with your GP practice. This is known as a Type 1 Opt-out.

Your Details

Name *

Date of Brith *

Phone Number

Address *

Postocde *

YOU CAN REGISTER A TYPE 1 OPT-OUT AT ANY TIME. IF YOU DO NOT WANT YOUR PATIENT DATA SHARED WITH NHS DIGITAL, YOU CAN REGISTER A TYPE 1 OPT-OUT WITH US.

NHS DIGITAL WILL NOT COLLECT ANY PATIENT DATA FOR PATIENTS WHO HAVE ALREADY REGISTERED A TYPE 1 OPT-OUT IN LINE WITH CURRENT POLICY. IF THIS CHANGES PATIENTS WHO HAVE REGISTERED A TYPE 1 OPT-OUT WILL BE INFORMED

PATIENT RECORD SHARING OPT-OUT (TYPE 1)

I do not wish to share my health record with other healthcare services providing care for me.

Date *

YOU CAN CHANGE YOUR MIND AT ANY TIME AND WITHDRAW A TYPE 1 OPT-OUT

Withdraw Opt-out (Opt-in)

I do allow my identifiable patient data to be shared outside of the GP practice for purposes beyond my own care

Date *

Type 2 OPT-OUT (Also known as National Data Opt-out)

If you do not want NHS Digital to share your patient data with anyone else for purposes beyond your own care, which has been already shared with them (or to opt back in, if you have previous opt'd out), You need to, either; Call 0300 303 5678 or, complete the online form via YOUR NHS MATTERS

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Page last reviewed: 20 September 2021
Page created: 06 December 2022

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Sharing Health Record Opt-Out Form (Type 1 OPT-OUT)

Sharing Health Record Opt-Out Form (Type 1 OPT-OUT)

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