New Patient Registration New Born

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Parent/Guardian's Details

Information we need to register you with the practice
Please note all fields marked with a * are mandatory for your registration

This form will allow you to register up to 4 New Born Babies.

If you are not already registered at the practice, you will need to complete a registration for yourself.

This first section is about the person completing the form

 
 
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Child's Details

Additional Contact Details

Child's Medical History

Please indicate which child examinations have been carried out

Child's Ethnic Status, Nationality & Language
 
Child's Data

Online Access

I wish to access my child's medical record online and understand and agree with each statement

Child's Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently.

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

If you do not complete this section, a Summary Care Record will be created for you based on implied consent

Child's ID Upload
 
 
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Children
Child's Details

Additional Contact Details

Child's Medical History

Please indicate which child examinations have been carried out

Child's Ethnic Status, Nationality & Language
 
Child's Data

Online Access

I wish to access my child's medical record online and understand and agree with each statement

Child's Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently.

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

If you do not complete this section, a Summary Care Record will be created for you based on implied consent

Child's ID Upload
 
Processing
Children
Child's Details

Additional Contact Details

Child's Medical History

Please indicate which child examinations have been carried out

Child's Ethnic Status, Nationality & Language
 
Child's Data

Online Access

I wish to access my child's medical record online and understand and agree with each statement

Child's Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently.

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

If you do not complete this section, a Summary Care Record will be created for you based on implied consent

Child's ID Upload
 
Processing
Children
Child's Details

Additional Contact Details

Child's Medical History

Please indicate which child examinations have been carried out

Child's Ethnic Status, Nationality & Language
Child's Data

Online Access

I wish to access my child's medical record online and understand and agree with each statement

Child's Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently.

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

If you do not complete this section, a Summary Care Record will be created for you based on implied consent

Child's ID Upload
 
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Mother's ID

What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

Privacy Consent

This form collects personal and medical information 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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