New Patient Registration: Under 14s

 

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Please complete our online form

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Child's Details

It is of enormous benefit to the Doctors and Nurses to know something about your child's medical background when you visit the practice since we may not have received your child's notes from your previous practice for some time.
Please note all fields marked with a * are mandatory for your registration

if known
UK Mobile only
nominate a pharmacy means we can send any prescriptions directly to the pharmacy without you needing to come to the surgery
include the full address and post code of your chosen pharmacy
Main Parent/Guardian/Carer's Details
Please note: Children will not be registered unless their legal guardian is a patient at this practice, or unless they are planning to register at the same time
please provide proof when you next visit the practice

Please submit birth certificate as proof when prompted.

please name all the people who live in the household with the child, and the relationship to the child.
Ethnicity & Language
School
Social Services
Allergies
 
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Supplementary Questions - If you are not a resident in the UK, but visiting or moving to the UK

These are supplementary questions and your answers will not affect your registration with us

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available at reception. Alternatively for more information go to the NHS Website 

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate action may be taken against me.

If you are from abroad
Please use this date format: DD/MM/YYYY
  
 
If you are returning from abroad

Previously been registered with the NHS in the UK

Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
European Economic Area (EEA) Country

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

Please enter the details from your EHIC or PRC below.

Previous Details
Please include postcode, if you have never lived in the UK, type "never lived in UK before"
if you have never had a GP before, type "never had a GP in the UK before"
 
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Carers

A carer is anyone, including children and adults who looks after a family member, partner, or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.

This does not mean your normal parenting duties for your child

UK number only
If a company of organisation, please indicate which above.
Immunisation History

Please attach any records (such as your redbook/vaccination book) of vaccinations/ immunisations/ injections your child has had in the UK or from any other country (or bring into reception so we can take a photocopy)

We will check if your child is due any additional/missing vaccinations and call you to book them an appointment with a nurse

Medical History of your Child
Please include dates.
Please include dates.
Please include dates.
include dosage, and frequency and what it is for
 
 
 
Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently.

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

If you do not return this form, a Summary Care Record will be created for you based on implied consent

Dear Patient,

There are currently three different data sharing schemes running nationally; Local Data Sharing, the Summary Care Record and NHS Digital Data and Information Collection data sets.

It is important that patients know the difference between Local Data Sharing, the Summary Care Record and NHS Digital Data and Information Collection data sets, so that an informed choice can be made about whether you are happy for your data to be shared, or whether you wish to opt out.

We want to be sure that we give you the opportunity to decide at what level you would like to opt out of data sharing and are aware of the implications.

You can also opt out of receiving text messages from the surgery. The surgery sends texts relating to your appointments, health reminders or campaigns. Please ensure we have your correct mobile number if you want to receive these texts.

Please complete the attached form and return it to us so we can be clear about your wishes.

A data sharing agreement exists between other clinical services that we refer you to. There are local services that are run as a federation of practices; caring for patients and providing cover Monday to Sunday 8-8 at the Hub.

If a patient does not opt out, their information will be shared when immediate patient care is needed.

A Summary Care Record is an electronic record that is stored at a central location. It contains information about medicines, allergies, or reactions to medicines that a patient has had. The record does not include detailed information about a patient’s medical history. Only healthcare staff directly involved in the patient’s care who have access to this information. Having this information stored in one place makes it easier for healthcare staff to treat patients in an emergency. The information being shared could be critical in an emergency situation. If a patient does not opt out, they will automatically have a Summary Care Record; however a patient can opt out of or re-join the scheme at any time.

The NHS would like to link information from all the different places where patients receive care, to help them compare the care patients receive in one area against another, so they can see what has worked best. Information such as a patient’s postcode and NHS number, but not their name, will be used to link their records in a secure system, so their identity is protected. Information which does not reveal their identity can then be used by others, such as researchers and those planning health services, to make sure the NHS provide the best care possible for everyone. How patient information is used and shared is controlled by law and strict rules are in place to protect patient privacy. If a patient does not opt out, their information will be shared; however a patient can opt out of or re-join the scheme at any time.

 
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What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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