Extraction of Confidential Data

advertisement

I N S O N

K

Dr Janet Cooke MBChB DRCOG MRCGP

Dr Andrew Brewer BSc MBBS

Dr Ian Heatley MBChB DRCOG DOccMed

440 Kinson Road Kinson Bournemouth BH10 5EY Tel: 01202 574604

Fax: 01202 590029

Extraction of Confidential Data for the Health & Social Care Information Centre (HSCIC)

The Care.Data Programme

Please tick as appropriate

I confirm that I DO NOT want any confidential data being extracted from my GP medical record and used by the Health & Social Care Information

Centre.

I confirm that I DO NOT want any confidential data leaving the Health &

Social Care Information Centre.

Name: ……………………………………………………Date of Birth: …………

(Please print)

Address:…………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………

Signed: ……………………………………………Date: …………………….

__________________________________________________________

Action by Surgery:

Read code 9Nu0 has been added to this patient’s record to ensure no data is extracted.

Read code 9Nu4 has been added to this patient’s record to ensure no data is extracted

Signed: ………………………………….. Name: …………………………..

Date a ctioned: …………………………………..

Branch Surgery: West Howe Clinic Cunningham Crescent Bournemouth BH11 8DN Tel: 01202 581981

Download