Patient Consent Form for Detailed Coded Record Access

If you would like to have secure access to view your coded medical record, we need to make sure that you understand what this involves. The following form will take you through the things you need to think about. By completing this form you will be giving us your permission to go ahead with setting you up with access to this new part on our online service. If you decide not to join or wish to withdraw, this will not affect your healthcare treatment in any way.

Access is granted at the discretion of your GP. Your request can take up to 28 days to process. You will be informed if access is not granted.

Patient Consent Form for Detailed Coded Record Access
Do you currently have patient access to online services? *
Please Register for Online Services before finishing this form.

Declaration

Please note this does not affect your rights of Subject Access under the Data Protection Act 2018

Other Considerations

Wargrave Surgery makes every effort to record information as accurately as possible, however there may be information that you do not feel is correct.

Patient Details

Please use date format DD/MM/YYYY
Any responses will be sent to this email.

For staff use only