NHS Data Grab- Form to prevent your information being shared.

NHS Data Grab- Form to prevent your information being shared.

Dissent from secondary use of GP patient identifiable data

Dear Dr

I am writing to give notice that I refuse consent for my identifiable information / and the identifiable information of those for whom I am responsible [delete as appropriate] to be transferred from your practice systems for any purpose other than my medical care.

Please take whatever steps necessary to ensure my / our confidential personal information is not uploaded and record my dissent by whatever means possible.

This includes adding the ‘Dissent from secondary use of GP patient identifiable data’ code (Read v2: 9Nu0, CTV3: XaZ89 or SNOMED CT: 827241000000103) to my / our records.

I am aware of the implications of this request, understand it will not affect the care that I / we receive, and I will notify you should I change my mind.

Yours sincerely,

Signature                                                                                

Date                                          

Information to help identify my records [please complete in BLOCK CAPITALS]

Title                 

Surname / Family name                                                                                     

Forename(s)                                                                                                                                       

Address                                                                                                                                              

Postcode                                                          

Date of birth                                                     

NHS number (if known)                                                                             

Space for additional patient details overleaf

NHS Digital says GP practices are required to action this opt-out, see: http://bit.ly/NHSDigital-Type1-opt-out

More copies of this letter can be downloaded from www.medconfidential.org/how-to-opt-out