Care.data opt out

Dear Doctor, I am writing to give notice that I refuse consent for my identifiable information to be transferred from your practice systems for any purpose other than my personal medical care.

Please take whatever steps necessary to ensure my confidential personal information is not uploaded and record my dissent by whatever means possible. This includes adding the ‘Dissent from secondary use of GP patient identifiable data’ code (Read v2:9Nu0 or CVT3: XaZ89) to my record as well as the ‘Dissent from disclosure of personal confidential data by Health and Social Care Information Centre’ code (Read v2: 9Nu4 or CTV3: XaaVL).

I am aware of the implications of this request, understand that it will not affect the care we receive and will notify you should I change my mind.

Question Title

* 1. Please provide your contact details

Name:

Address 1:

Address 2:

City/Town:

Postal Code:

Country:

Email Address:

Phone Number:

Question Title

* 2. I am writing to give notice that I refuse consent for identifiable information of those for whom I am responsible to be transferred from your practice systems for any purpose other than their personal medical care.

I am aware of the implications of this request, understand that it will not affect the care we receive and will notify you should I change my mind.

Name:

Date Of Birth:

Name:

Date of Birth:

Name:

Date of Birth:

Question Title

* 3. Haughton Thornley Medical Centres recommends patients should be able to see their own records and share them with whom they like if they can, understand their own health using the links on the practice website www.htmc.co.uk and to discuss this with their clinician. Would you like us to contact you so that you can have access to your records?

Yes - could you please contact me

No - I do not wish to have access to my records

I already have access to my records

I had access to my records but it is not working. Could you please contact me

Any comments including whether you would like us to email you, phone you, ask another patient to show you what it is or whether you would like to come to a meeting to learn more