Summary care record choice form

Summary Care Record Choice Form

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Patient Address (including postcode):

Patient NHS number (if known):

Summary care record choice:

Yes, I would like a summary care record containing details of my current medication, allergies, and any bad reactions to medication.

Yes, I would like a summary care record containing details of my current medication, allergies, any bad reactions to medication, and additional information that I have agreed with my GP practice to include.

No, I do not want a summary care record to be created or shared.

If you have not selected an option previously, a summary care record will have been created for you on implied consent.

What does it mean if you do not have a summary care record?

NHS staff caring for you may not be aware of your current medications, allergies you suffer from and any bad reactions to medicines you have had, in order to treat you safely in an emergency.

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What does it mean if you do not have a summary care record?