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Type 1 Data Opt-Out Form

Information about you and the care you receive is shared, in a secure system, by healthcare staff to support your treatment and care.

It is important that the NHS can use this information to plan and improve services for all patients. The NHS would like to link information from all the different places where you receive care, such as your GP, hospital and community services, to help provide a full picture. This will allow the NHS to compare the care you received in one area against the care you received in another, so the NHS can see what has worked best.

Information such as your postcode and NHS number, but not your name, will be used by NHS Digital to link your records in a secure system, so your identity is protected.

You have a choice. If you are happy for your information to be used in this way you do not have to do anything. If you have any concerns or wish to prevent this from happening, please complete the Data Opt-Out form below.

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Please select one(Required)

I do NOT want my personal confidential data to be released by Orchid House Surgery for any purpose other than our medical care.

I do NOT want personal confidential data of those for whom I am responsible to be released by Orchid House Surgery for any purpose other than our medical care.

Please record my dissent by whatever means possible. This includes adding the ‘Dissent from secondary use of GP patient identifiable data’ code to my record.

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.

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Date of Birth(Required)

NHS Number (if known)