Abingdon Medical Practice
12 Stewartville Street Glasgow G11 5PE
New Patient Registration
DATE
IF FROM OUTWITH UK
Country of origin 134..
Main spoken language 131..
Name
Address
Date of birth:
Interpreter required?
Yes (9NU0.) / No (9NU1.)
Occupation (13q..)
Telephone
Mobile number
E-mail address
Work telephone
Past Medical History
1.
2.
3.
4.
Current drug therapy
1.
5.
2.
6.
3.
4.
Allergies to drugs/other substances:
No known allergies 1151.
Family history (12…):has any first degree relative suffered from any of the
following?-if so, please provide details:
Cancer: Breast / Bowel/Colon /Ovary
Stroke age < 60/ Heart attack or angina age < 60 /Asthma /Osteoporosis/ Diabetes
Do you smoke?* Yes/No – amount:
Do you take alcohol-Yes/No Amount/week?
Exercise type/frequency/week:
*The Practice staff can offer literature and advice re other Smoking cessation
services on request
Carer Identification
(918G.)
A carer is someone, who, without payment, provides help and support to a partner,
child, relative, friend or neighbour, who could not manage without their help. This
could be due to age, physical or mental illness, addiction or disability.
Are you a carer? –if so please make this known to the Practice, and note that you are
entitled to request referral to Social Work and/or Carers Support Services for help and
advice.
Dr J M McConnell Dr Georgi Georgiev
Tel 0141 339 0902
Coding completed 
Date
Initials
Abingdon Medical Practice
12 Stewartville Street Glasgow G11 5PE
Screening
Women-Last cervical smear –date/result
Women-Last breast screen (Mammogram)-date/result
Vaccinations dates where possible of previous vaccinations

Diphtheria/Tetanus

Polio

MMR/Rubella
EXAMINATION Practice Nurse/Health Care Assistant
DATE:
Height
Weight
Blood Pressure
Urinalysis
461..
Glucose + / -
Albumin + / -
Family history READ CODES
Premature Heart Disease age < 60 12C2
Premature Stroke Disease age < 60 12C4
Diabetes
1252
Breast Cancer 1243
Ovarian Cancer 1245
Colon Cancer 1241
Asthma 12D2
Osteoporosis 1268
Can add details of relative affected, age etc in freetext
Notes on vaccinations

Tetanus/Diphtheria: 5 per lifetime unless receive a tetanus prone injury.
Those born in/before 1960 and not in armed forces may not have received
primary immunisations. Offer booster or course where indicated especially
elderly(Revaxis Td/IPV)

Polio: Born before 1958 may not have received primary immunisation
Check! Offer course/booster as required (Revaxis Td/IPV)

MMR offer to all 17-29 year olds/ born before 1988 ( when MMR
introduced) Local Enhanced Service

Meningitis C 16-24 years offer if not previously immunised
Dr J M McConnell Dr Georgi Georgiev
Tel 0141 339 0902
Abingdon Medical Practice
12 Stewartville Street Glasgow G11 5PE
ETHNIC MONITORING PATIENT INFORMATION
During your visit to your Doctors surgery you will have the opportunity to make sure
we have all your up-to-date information .This is important information such as your
current address and telephone number.
The NHS is also recording other important information such as language and also
ethnic group. The reason we are recording this information is:
 To help us communicate effectively and safely with all our patients
 To help us understand health related to specific ethnic groups
 To help us monitor our services
 To help us when planning new services
 To help us promote racial equality
This information is confidential and is only used for health purposes. It is not used by
any other organisations. The information is NOT used by immigration or benefit
agencies.
Thank you for taking the time to fill in the form
Ethnic Group
A. White
Scottish (9S13)
Other British (9S14)
Irish (9S11)
Any other White background (specify)
(9S12)
B. Mixed
Any mixed background (specify)
(9SB)
C. Asian, Asian Scottish, Asian British
Indian (9S6)
Pakistani (9S7)
Bangladeshi (9S8)
Chinese (9S9)
Any other Asian background (specify)
(9SH)
D. Black, Black Scottish or Black British
Caribbean (9S2)
African (9S3)
Any other Black background (specify)
(9SG)
E. Other ethnic Background
Any other background (specify)
(9SJ)
F. Other
Prefer not to say (9SD)
Dr J M McConnell Dr Georgi Georgiev
Tel 0141 339 0902