Opt out of Care Data

1Opt out of Care Data

I am writing to decline my consent for my identifiable patient information to be transferred from your Practice for any purpose other rhan my medical care. Please code my records accordingly.

I do not wish my clinical data to be extraced electronically from this GP practice. Please add the code 9Nu0 'Dissent from secondary use of GP patient identifiable data' to my medical records.

I am aware of the implications of this request and understand that it will not affect the care I receive. I will notify you should I change my mind.


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


© Dordon and Polesworth Group Practice 2018
Dordon Surgery - 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1QA
Polesworth Surgery - High Street, Polesworth , Tamworth, Staffordshire, B78 1DU
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