Summary Care Record / Opt Out Form

Data relating to your care is held under the control of the GPs in a secure fashion. We also share data within the NHS for the purposes of your care. This form allows you to refuse this data sharing at various levels. Please read this in conjunction with information held on our own website and also that of the CCG and NHS and CSCIC nationally.

I have read and understood the information provided and I refuse permission for my data to be shared in the following ways.

Please indicate if you refuse for each item by filling in the form below. (a national database held by the Information Centre)

Summary Care Record

Please use this date format: DD/MM/YYYY.