E Contact Type 1 opt-out: medical records held at your GP practice

Last Updated: 17/07/2023

PATIENT DETAILS

Patient First Name *

Patient Surname Name *

Postcode *

Gender (We know that the options above do not represent everyone. We have to ask this question as it’s one of the necessary pieces of information for us to match your enquiry to your medical record. This means your GP can locate your record and deal with your request faster.) *

Male

Female

Other

Patient Date of Birth *

PATIENT NHS Number www.nhs.uk/nhs-services/online-services/find-nhs-number/ *

PATIENT Telephone Number *

PATIENT Mobile Telephone NUMBER *

Type 1 opt out form

You can choose whether your confidential patient information is used for research and planning. To find out more visit https://www.nhs.uk/your-nhs-data-matters/

You do not need to do anything if you are happy about how your confidential patient information is used. You can change your choice at any time.

Type 1 opt-out: medical records held at your GP practice

You can also tell your GP practice if you do not want your confidential patient information held in your GP medical record to be used for purposes other than your individual care. This is commonly called a type 1 opt-out. This opt-out request can only be recorded by your GP practice.

Type 2 opt-out: information held by NHS Digital

Previously you could tell your GP practice if you did not want us, NHS Digital, to share confidential patient information that we collect from across the health and care service for purposes other than your individual care. This was called a type 2 opt-out.

The type 2 opt-out was replaced by the national data opt-out. Type 2 opt-outs recorded on or before 11 October 2018 have been automatically converted to national data opt-outs.

Read more about the collection and conversion of type 2 opt-outs. https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe/how-we-look-after-your-health-and-care-information/your-information-choices/how-opt-outs-work

How to find your NHS number

https://www.nhs.uk/find-nhs-number/what-is-your-name

I give notice that I refuse consent for my identifiable information to be transferred from my GP practice systems for any purpose other than my medical care. Please record my dissent by adding the ‘Dissent from secondary use of GP patient identifiable data’ code to my records. *

I understand and agree to the above statement.

THE SURGERY WILL BE IN CONTACT WITH YOU REGARDING YOUR REQUEST WITHIN 5 WORKING DAYS, THIS COULD BE VIA TELEPHONE, TEXT OR EMAIL AND I AGREE NOT TO CONTACT THE SURGERY UNTIL AFTER THIS TIME REGARDING THIS REQUEST. *

I agree to the above statement

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E Contact Type 1 opt-out: medical records held at your GP practice

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