Health record opt out

Section

Address:

NHS Number:

If known

Conditions for opt out

If you are unsure what boxes to tick please consult with your practice staff for advice.

1) If you wish to object to the sharing of your patient identifiable data.

Type of Objection:

If you wish to object to information about you from leaving the general practice for purposes other than direct care (Type 1 objection)

If you wish to object to any information about you from leaving the Health and Social Care Information Centre (HSCIC) for purposes other than direct care (Type 2 objection)

2) If you wish to withdraw your objection to the sharing of your patient identifiable data.

Type of Objection:

If you wish to withdraw dissent to information about you from leaving the general practice for purposes other than direct care (Type 1 objection)

If you wish to withdraw dissent to any information about you from leaving the HSCIC for purposes other than direct care (Type 2 objection)

3) Consent to share de-identified or pseudonymised data with specified third parties (Apollo and MedeAnalytic) for use by local health and social care to provide a more joined up service.

Consent/Objection:

Consent to share patient data with specified third party.

Declined consent to share patient data with specified third party.

Consent to option 3 can be selected along-side the type 1 and 2 objections and further details of the local schemes can be found in a leaflet from your general practice or at: www.enhertsccg.nhs.uk

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Section

Conditions for opt out

1) If you wish to object to the sharing of your patient identifiable data.

2) If you wish to withdraw your objection to the sharing of your patient identifiable data.

3) Consent to share de-identified or pseudonymised data with specified third parties (Apollo and MedeAnalytic) for use by local health and social care to provide a more joined up service.