020 7923 8100
  • Summary Care Records Opt Out Form

  • Request for my clinical information to be withheld from the Summary Care Record.

    If you DO NOT want a Summary Care Record please complete this form.

  • Clear
  • B. If you are filling out this form on behalf of another person or a child, their GP practice will consider this request.
    Please ensure you fill out their details in section A and your details in section B

  • Clear
  • What does it mean if I DO NOT have a Summary Care Record?

    NHS healthcare 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. Your records will stay as they are now with information being shared by letter, email, fax or phone. If you have any questions, or if you want to discuss your choices, please:

    • phone the Summary Care Record
    Information Line on
    0300 123 3020;
    • contact your local Patient Advice
    Liaison Service (PALS); or
    • contact your GP practice.

  • Should be Empty: