Data Sharing Form

 

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Introduction

This form details the options we offer you regarding sharing your data electronically with other care organisations and with yourself. Please read each section carefully and indicate your preferences.

IF THE PATIENT IS UNDER 16 (OR DOES NOT HAVE CAPACITY) AN ADDITIONAL PROXY FORM IS REQUIRED. PLEASE CONTACT RECEPTION.

Personal Details
Please double check you've entered the correct email address
May be used to identify you
Preferred Method Of Communication

Ammonite Health would like to contact you by text message and/or e-mail. During this digital age, text messages and e-mails are an efficient way to communicate with patients. If you agree to receive text messages and/or e-mails from the practice, this will include:

  • appointment booking confirmation (text message)
  • appointment booking reminder the day before your appointment (text message)
  • notification of missed appointment (text message)
  • requests for you to contact the practice
  • notification when test results are back, and if we need to speak to you
  • reminders to book an appointment (e.g. for immunisations, annual check-ups, blood tests)
  • invitation to appointments you are eligible for (e.g. NHS health checks, cervical screening)
  • health campaign information
  • practice information/updates (e.g. change in opening hours, new service starting, etc)
  • information about the status of a referral to hospital or specialist service
  • information about your medication and prescriptions
  • information about other services (e.g. contact details)
  • requests for feedback following attendance at the practice (e.g. friends and family test)
Summary Care Records

A summary care record is an electronic record of important information about your health. It will be available to health care staff providing your NHS care. In the case of an emergency this allows other NHS healthcare agents to gain access to information about you including details of your medications, allergies and any other relevant information. Please read our ‘How We Use Your Health Records’ leaflet for more detailed information.

Online Access To Online Services

The clinical system we use at Ammonite Health is called SystmOne. This system offers patients over the age of 16 the option to enrol in online services in order to book appointments, request repeat prescriptions and access their summary care record through a web page or app.  If you are not the patient (i.e. you are a parent or carer) and you wish to access these online services on their behalf, then please ask for information about proxy access. If you would like to enrol in this service, please ensure you bring one form of photographic ID (passport or driving licence) plus an additional proof of address when returning this form.

Online Access To Your Detailed Coded Record

SystmOne offers patients the option to see their detailed coded record online via a webpage or app.  A detailed coded record includes the following information: 

  • demographics
  • allergies/adverse reactions
  • medication (dose, quantity, last issued date)
  • immunisations
  • results (numerical values and normal ranges)
  • values (e.g. blood pressure, peak expiratory flow rate)
  • problems/diagnoses
  • procedure codes (medical or surgical) and codes in consultation (signs, symptoms)
  • codes showing referral made or letters received (no attachments)
  • other codes (ethnicity, quality and outcomes framework)

Detailed coded records do not contain free text or letters and so may not always be easy to understand. Please read our leaflet ‘Online Access to Medical Records’ for more information on this service and some abbreviations that might help you.

Sharing Your Information Using SystmOne GP Clinical System

Another way of sharing your information for your care is through the confidential electronic record system that we use in our practice (SystmOne).  This system is used widely across the NHS and care organisations to keep accurate medical records about you.  These records store important information about your illnesses and the care you have received in the past.  Your record may contain information from different health and social care organisations such as a hospital, a minor injuries unit, or from a community care service such as district nursing. 

Organisations can only access your medical record if you give them permission.  For example, you may be working or on holiday in another part of the country and need care from a hospital or a clinic.  Having access to your whole medical record will improve the care they can provide you. 

Data Sharing For Other Purposes Such As Research

The NHS wants to make sure you and your family have the best care now and in the future. Your health and adult social care information supports your individual care. It also helps the NHS to research, plan and improve health and care services in England. Unless you have chosen to opt out, your confidential patient information can be used for research and planning. An online service allows you to make or change your decision at any time. You can also download a form to manage a choice on behalf of another individual by proxy. 

If you do not want your confidential patient information to be used for research and planning, you can opt out of this. Your confidential patient information will still be used to support your individual care. Any choice you set using this service will not change this.

You may use the online service, or request a print-and-post form, to make or change your choice at any time. You can also request assistance or make your choice using the telephone service (0300 303 5678). If you do not wish to opt out, you do not have to do anything at all.

ID Upload
Patient Signature
FOR PRACTICE USE ONLY

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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