Registration Part II

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Patient Details
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Cervical Screening
Data Sharing Consent

There are strict laws and regulations to ensure that your health records are kept confidential and can oly be accessed by health professionals directly involved in your care. There is some sharing of information as detailed below. You can opt out of any of these are any time if you wish.

HIE -Health and care organisations across North Central London (NCL) are working together to use joined-up health and care records to help to improve the standard and safety of care for resudents. As of the 20 September 2020, NHS NCL CCG -Camden Borough Directorate, replaced the patient records portal, the Care integrated Digital Record (CIDR), with a new system, the Health Information Exchange (HIE). HIE gives care providors the ability to access in one easy-to-view real-time record, a patient's care across health and care services in north central London as well as the rest of London. For more information see leaflet.

Summary Care Record (SCR) -this is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had. Having this information stored in one place makes it easier for healthcare staff to treat you in an emergency, or when the GP practice is closed.

NHS Digital and 'Your Data Matters to the NHS' -Information about your health and care helps the NHS to improve your individual care, speed up diagnosis, plan your local services and research new treatments. In May 2028, the strict rules about how this data can and annot be used were strengthened. The NHS is committed to keeping patient information safe and always being clear about how it is used. You can choose whether your confidential patient information is used for research and planning. You do not need to do anything if you are happy about how your confidential patient information is used. If you do not want your confidential patient information to be used for research and planning, you can choose to opt out securely online or through a telephone service. Tofind out more or to make your choice visit: or call 0300 303 5678


PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

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 of the European Economic Area must also have the status of 'indefinite leane to remain' in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those doseases 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, exemption and paying for NHS services can be found in the Visitor and Migrant patient leaflet available from your GP practice.

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 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 purpose of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

Please tick one of the following boxes:

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.

A parent/guardian should complete the form on bealf of a child under 16.


Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.



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.


How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purpose of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

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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