Summary Care Record Opt-Out

National Data Opt-out

If you don’t want your confidential patient information to be shared by NHS Digital for purposes except your own care – either GP data, or other data we hold, such as hospital data – you can register a National Data Opt-out.

If you DO NOT want a Summary Care Record please ﬁll out the form. Your clinical information will be withheld from the Summary Care Record.

Section A

Title

Full Name

Date of Birth

Contact Number

Address

Postcode

NHS Number

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

Section B

Title

Full Name

Relationship to Patient

Confirmed opt out

I do not want my information to be shared. I am aware that NHS healthcare staff caring for me may not be aware of my current medications, allergies I suffer from and any bad reactions to medicines that I have had, in order to treat me safely in an emergency.

I have read and agree to the website privacy policy

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