Summary Care Record opt out

The Summary Care Record (SCR) is an NHS Digital programme of work which enables authorised healthcare staff to view a summary of patients’ key information held by your GP practice in urgent and emergency care settings, anywhere in the NHS in England.

It includes details of any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced. Your Summary Care Record also includes your name, address, date of birth and your unique NHS Number to help identify you correctly. As part of a mandatory national programme each GP Practice had to make a summary care record for each patient by March 2015 (unless the patient has already opted out). You can choose to opt out of this scheme at any time.

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Please confirm that you have read and understood the information about Summary Care Records

Section A

If you are filling this form on behalf of another person or child please ensure you fill their details in section A and your details in section B.

Full Name:

Address (including postcode):

Phone Number:

NHS number (if known):

Section B

If you are filling this form on behalf of another person or child please ensure you fill their details in section A and your details in section B.

Your name:

Electronic Signature:

Relationship to patient:

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Section B