Electronic Patient Record Consent/Dissent

If you wish to have your consent or dissent recorded for your Electronic Patient Record, please complete this form.

Record Sharing

Record Sharing

Please use format DD/MM/YYYY
You can in consultation with your Health Care Professional, choose to permit or restrict access to the information entered into your record at each ‘SystmOne’* organisation that access your medical record.
This will allow you to decide who can see the information on your electronic record and allow for care across different NHS settings in order to give you the best care and service. You can still request for individual entries in your patient record to be marked as ‘Private’ and these will not be visible to any care service other than the one that recorded the information.

Why is this necessary?

If you are unconscious, doctors would be able to access your electronic record without first asking your permission (use of this will be monitored).

Sharing Out

Do you consent to the sharing of data recorded here with any other SystmOne organisation that may care for you? *

Sharing In

Do you consent to the viewing of data from other care services where you have already agreed to make data shareable? *

* SystmOne’ is the clinical system we use here at St Peters Surgery to record your medical information.