Summary Care Record Choices

Your Summary Care Record is a short summary of your GP medical records. It tells other health and care staff who care for you about the medicines you take and your allergies.

This means they can give you better care if you need health care away from your usual doctor’s surgery, for instance in A&E or when you’re on holiday.

Please read the following information before making your choice:

Important information about Summary Care Records

If you are human, leave this field blank.

Section

Patient Address (including postcode): *

NHS Number (if known):

Choices

Having read the important information regarding your choices, please choose one of the options below:

Yes - I would like a Summary Care Record - Express consent for medication, allergies and adverse reactions only

Yes - I would like a Summary Care Record - Express consent for medication, allergies, adverse reactions and additional information

No – I would not like a Summary Care Record - Express dissent for Summary Care Record (opt out)

Signature: *

Date:

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