Summary Care Record Opt Out - Wells Health Centre

Your Summary Care Record is a short summary of your GP medical records. It tells other health and care staff who care for you about the medicines you take and your allergies.

This means they can give you better care if you need health care away from your usual doctor’s surgery, for instance in A&E or when you’re on holiday.

If you agree, we will include additional information in your Summary Care Record. This will help you get better care when you are away from the GP practice.

If you wish to opt out of the Summary Care Record scheme please complete this form.

Non-urgent advice: Please note

If you do not allow us to include additional information in your Summary Care Record, your care may be harmed if you get seriously ill.

Having read the above information regarding your choices, please choose one of the options below and return the completed form to your GP Practice:

Would you like a Summary Care Record?

Yes

No (Opt-Out)

Name of Patient

First Last

Address

Street Address Address Line 2 City Postcode

Date of Birth

NHS Number Optional

Signature

(Full Name)

Are you filling this form out on behalf of someone else?

Yes

Relationship to Patient

Parent

Legal Guardian

Lasting power of attorney for health and welfare

If you require any more information, please visit http://digital.nhs.uk/scr/patients or phone NHS Digital on 0300 303 5678 or speak to your GP practice.