Full Prospective Online Access OPT IN Form – Overdale Medical Practice

Online Access Opt In Form

Personal Details

Full Name

NHS Number

Date of Birth

Address

Address Line 1

Address Line 2

City

Postcode

Patient Information

Things to consider when gaining online access to your medical records:

• FORGOTTON HISTORY – There may be something you have forgotten about in your record that you might find upsetting and do not want to be reminded about.

• ABNORMAL RESULTS OR BAD NEWS – If your GP has given you access to test results or letters, you may see something that you find upsetting to you. This may occur before you have spoken to your doctor or while the surgery is closed, and you cannot contact them.

• CHOOSING TO SHARE YOUR INFORMATION WITH SOMEONE ELSE – It’s up to you whether you share your information with others – perhaps family members or carers. It’s your choice, but also your responsibility to keep the information safe and secure. We will not be able to monitor this on your behalf.

• COERCION – If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time.

• MISUNDERSTOOD INFORMATION – Your medical record is designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information within your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification, please contact the surgery for a clearer explanation.

• INFORMATION ABOUT SOMEONE ELSE – If you spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible. It is important you keep your username and password safe, if at any time you believe your password has been compromised, please contact the surgery immediately.

Please read and tick the following statements:

1. I have read and understood the information above.

2. I will be responsible for the security of the information that I see or download.

3. If I choose to share my information with anyone else, this is at my own risk.

4. If I suspect that my account has been accessed by someone without my agreement, I will contact the practice as soon as possible.

5. If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible.

6. If I think that I may come under pressure to give access to someone else unwillingly I will contact the practice as soon as possible.

I confirm that I have read and understood the above information and wish to have access to my Full Prospective Online Access

Yes

If using SystmOnline do you require a new username and password?

Yes