Summary Care Record - Dr GT Hendow

Your Summary Care Record will contain important information about any medicines you are taking, allergies you suffer from and any bad reactions to medicines that you have had.

Giving healthcare staff access to this information can prevent mistakes being made when caring for you in an emergency or when your GP practice is closed. Your Summary Care Record will also include your name, address, date of birth and your unique NHS Number to help identify you correctly.

You may want to add other details about your care to your Summary Care Record. This will only happen if you ask for the information to be included. You should discuss your wishes with the healthcare staff treating you.

You can choose not to have a Summary Care Record. You need to let your GP practice know by filling in and returning an opt-out form.

Download Summary Care Records Opt-Out Form

This online form is for you to request that your clinical information be withheld from the Summary Care Record.

Summary Care Records Opt-Out Form

Section A

Name *

Date of Birth *

Gender *

Female

Male

Address *

Address

City

State/Province

Zip/Postal

Country

Email *

Home/ Main Phone Number *

Section B -If you are filling out this form on behalf of another person or child, their GP practice will consider this request. Please ensure you fill out their details in section A and your details in section B.

Name

Relationship To Patient

Todays Date *