Full Online Access Application

Has the practice sent you this form to complete?

Please only complete the form below if you have been asked to and have already completed a register for online services form.

Online Access To Medical Records

I wish to have access to the following services:

I wish to have full access to my medical records online and understand and agree with the below statements:

Online Services Records Access – Patient information leaflet

If you wish to, you can now use the internet to book appointments with a GP, request repeat prescriptions for any medications you take regularly and look at your medical record online. You can also still use the telephone or call in to the surgery for any of these services as well. It’s your choice.

Being able to see your record online might help you to manage your medical conditions. It also means that you can even access it from anywhere in the world should you require medical treatment on holiday. If you decide not to join or wish to withdraw, this is your choice and practice staff will continue to treat you in the same way as before. In general this decision will not affect the quality of your care.

You will be given login details, so you will need to think of a password which is unique to you. This will ensure that only you are able to access your record – unless you choose to share your details with a family member or carer.

It will be your responsibility to keep your login details and password safe and secure. If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately.

If you can’t do this for some reason, we recommend that you contact the practice so that they can remove online access until you are able to reset your password.

If you print out any information from your record, it is also your responsibility to keep this secure. If you are at all worried about keeping printed copies safe, we recommend that you do not make copies at all.

The practice has the right to remove online access to services for anyone that doesn’t use them responsibly.

Online Access to Medical Records Questionnaire

This questionnaire is to help the practice check your understanding and suitability for Online Access to your Full Medical Record.

Before you start this questionnaire please consider the following:

Forgotten history

There may be something you have forgotten about in your record that you might find upsetting.

Abnormal results or bad news

If your GP has given you access to test results or letters, you may see something that you find upsetting to you. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them.

Choosing to share your information with someone

It’s up to you whether or not you share your information with others – perhaps family members or carers. It’s your choice, but also your responsibility to keep the information safe and secure.

Coercion

If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time.

Misunderstood information

Your medical record is designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information within your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification, please contact the surgery for a clearer explanation.

Information about someone else

If you spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible.

I wish to access my medical records online and I agree that I have read and understood the information leaflet provided.
I will be responsible for keeping any information I read, copy, download or print, safe and secure.
I am completing this questionnaire for myself.
I am confident using my login and password to access Online Services.
I agree that if I chose to share my information with anyone else, this is at my own risk.
I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement.
There may be an instance when accessing my medical records online; I may read some information that could be unexpected or upsetting. If this happens, especially if the surgery is closed, I would:
Tick all that apply
A new letter is showing in my health record, when I open the letter I find that it is for another patient. If this happened I would:
Tick all that apply
If I read information in my record that someone else such as a family member or health professional has said about me would it upset me?
Tick all that apply
I feel that I fully understand what Record Access means.