Summary Care Record – Your Emergency Care Summary

The NHS in England is introducing the Summary Care Record, which will be used in emergency care. The record will contain information about any medicines you are taking, allergies you suffer from and any bad reactions to medicines you have had, to ensure that those caring for you have enough information to treat you safely.

Your Summary Care Record will be available, in the near future, to authorised healthcare staff providing your care anywhere in England, but they will ask for your permission before they look at it. This means thatif you have an accident or become ill, healthcare staff treating you will have immediate access to important information about your health.

Children under 16 will automatically have a Summary Care Record created for them unless their parent or guardian chooses to opt them out. If you are the parent or guardian of a child under 16 and feel that they are old enough to understand, then you should make this information available to them.

For further information please ask your practice for an SCR information booklet. You can alsotalk to our Patient Advice and Liaison Service (PALS) (0800 015 1462), visit the website or telephone the dedicated NHS Summary Care Record Information Line (0300 123 3020)

As a patient you have a choice. You can choose not to have a Summary Care Record and you can change your mind at any time by informing your GP practice.

Please sign only one of the options below to confirm your wishes and return it to Reception:

Select below:Sign below:

1 / Yes - I want to have a Summary Care Record
2 / No - I do not want a Summary Care Record.
I am aware this will mean I have Opt Out for now.
3 / I don’t know whether I want a Summary Care Record and need more time to consider my options – this will mean I will NOT have an SCR until I inform my Practice otherwise and I am aware this will mean I have Opt Out for now.

Please be advised that we will create your Summary Care Record following your registration with this practice unless you express a preference otherwise.

Title: / Surname/Family name:
Forename(s): / Date of Birth:
Post Code: / Date:

Patient Preference Form – Version 1July 2012