DCRA Consent Form

You can now view your GP medical record online to look at test results, details of consultations and your medical history, including current and past medication.

If you would like to have secure online access to your records, we need to make sure that you understand what this involves and that you are happy for us to use the information about you (provided below) to set up and operate the service.

The following form will take you through the things you need to think about. By signing the form you will be giving us your permission to go ahead with setting up the service for you. If you decide not to join, or wish to withdraw, it will not affect your treatment in any way.

Access is granted at the discretion of the practice. Your request for access may take
up to 10 working days to process. You will be informed if access cannot be granted.

Consent for Detailed Coded Record Access

Declaration

I agree to my GP practice giving me access to my record online. *
I have been provided with an information leaflet about access to GP medical records which I have read and understood. *
I agree to use the system in a responsible manner in accordance with all instructions given to me by the practice. If not access may be withdrawn. *
If I see information which does not relate to me, I will immediately log out and report the matter to the practice as soon as possible. *
I agree that it is my responsibility to keep my username and passwords secure. If I think these have been shared inappropriately I will reset them using the instructions supplied. I am also responsible for keeping safe any information I may print from the record. *
I agree that my details below may be used to contact me about how useful I find the service and whether it could be improved. *
I understand that online access is granted at the discretion of the practice, taking into account my best interest. I will be informed of any decision to withdraw the service. Please note, this does not affect your right of Subject Access under the Data Protection Act. *

Other Considerations

The practice makes every effort to record information as accurately as possible, however there may be information that you do not feel is correct.

If I notice any inaccuracies with my record, I will inform the practice manager as soon as possible of any errors or omissions. *
I understand that I may see information on my record that I was unaware of / have forgotten about that could cause distress. *
I understand that as before, I will be informed directly, by the practice, of any test results which require further action. However I understand that I may see these results online before the practice has been able to contact me. This could be while the surgery is closed and there is no one available to discuss them with me. *

Patient Details

If this address is shared with others please consider whether you agree that it can be used to send you confidential information about your account / the services used.
Do you currently already have Patient Access Online Services?

After submitting this form, please complete the Register for Online Services form.