Appendices 2B Consent to Photography at Nottingham University Hospitals NHS Trust Medical Photography Patient Name: I wish to refer you to Medical Photography for clinical photographs to be taken. These images will be part of your medical records and will be used by The Plastic Surgery Working Group Panel to assess your referral. NHS No: DOB: Address: In view of the explanation given to me by: I consent to photographs being taken for my hospital notes & Plastic Surgery Working Group Panel Signature of patient /parent /guardian:…………………………………………….............................……. Print Name:....................................................... Relationship if not patient: ……………………………. Date ……….............................……………….. Signature of Healthcare professional ………………..................... Practice …………………………. Area to be photographed:................………… Views required:………………………………… NOTE FOR PATIENTS We have arranged two “drop-in” sessions per week with Medical Photography at Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB. Please follow signs for North Corridor, Junction N13. These times are: TUESDAY AFTERNOON from 13:00 to 15:45 and FRIDAY MORNING from 08:30 to 12:15 If these times are difficult or if you’d prefer to come to the QMC campus, please contact the Medical Photography department on 0115 9691169 extension 56493 Please attend for clinical photographs as soon as possible; it is very important that you attend as we may not be able to assess your G.P.’s referral and this may delay any treatment which you may require. Please include a measure in the close-up view NOTE FOR PHOTOGRAPHER Please upload images to GP Referral database. Jane Urquhart IFR Manager Photographer……….. Date....................