Summary care record opt-out

Request for your clinical information to be withheld from the Summary Care Record.

If you are completing this form on behalf of another person or child, please ensure you provide their details in the patient information section and your details in the carer's details section.

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What does it mean if I do not have a summary health care record?

NHS healthcare staff caring for you may not be aware of your current medications, allergies you suffer from and any bad reactions to medicines you have had, in order to treat you safely in an emergency.

Your records will stay as they are now with information being shared by letter, email, fax or phone.

If you have any questions, or if you want to discuss your choices, you can:

• Phone the Summary Care Record Information Line on 0300 123 3020
• Contact your local Patient Advice Liaison Service (PALS)
• Contact the practice