Dissent from secondary use of GP patient identifiable data

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Declaration

I am writing to give notice that I: *

To be transferred from your practice systems for any purpose other than my medical care.

Please take whatever steps necessary to ensure: *

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: *

I am aware of the implications of this request, understand it will not affect the care that: *

and I will notify you should I change my mind.

Personal Details

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

If you are unsure of your NHS Number you can find out how to locate it via the NHS wbsite

Privacy Consent

This form collects personal and medical informanot tion 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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CONTACT DETAILS

Budleigh Salterton Medical Centre
1 The Lawn
Budleigh Salterton, EX9 6LS

Enquiries: 01395 441 212
Out of Hours:111

Please note that all calls are recorded. A telephone call will only be retrieved and heard, should there be a clinical reason to do so for training purposes, or a complaint that requires investigation.

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Dissent from secondary use of GP patient identifiable data

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