Application for Online Access

 
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Application for Online Access

Online access to medical records

You can now book appointments, order repeat prescriptions and see; information in your GP records, including medications and allergies online.

  • The surgery has a responsibility to look after your GP records.
  • You must also take care online and make sure your personal information is not seen by anyone who should not see it.
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Access to GP Online Services Important Information

Please read before completing the form below:

If you wish to, you can now use the internet (via computer or mobile app) 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.

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 are unable to 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.

During the working day it is sometimes necessary for practice staff to input into your record, for example, to attach a document that has been received, or update your information. Therefore, you will notice admin/reception staff names alongside some of your medical information – this is quite normal.

The definition of a full medical record is all the information that is held in a patient’s record; this includes letters, documents, and any free text which has been added by practice staff, usually the GP. The coded record is all the information that is in the record in coded form, such as diagnoses, signs and symptoms (such as coughing, headache etc.) but excludes letters, documents and free text.

Before you apply for online access to your record, there are some other things to consider. Although the chances of any of these things happening are very small, you will be asked that you have read and understood the following before you are given login details.

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.

For further information, please see the NHS website.

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All questions marked with a * are mandatory

Keeping your password safe

Keeping your username and password safe

When you register to use Online Services, you will create your own username and password, which you will use to log in. You should not share your log in details with others.

To protect your information from other people:

  • You should keep your password secret and it is best not to write it down. If you must write it down, keep a reminder of the password, not the password itself. This should be kept in a secure place.
  • If you think someone has seen your password, you should change it as soon as possible. You may want to call the surgery if you are not able to change it right away, for example, when you do not have access to the internet.
  • You should not share your user name or password. No one should force you to show them your log in details, you have the right to say no. If someone forces you, tell the surgery as soon as possible.
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Using a shared computer

You need to take extra care when using a shared computer to look at your records online. This could be at the library, at work, at university or at home. To protect your personal information from others when using a shared computer. 

You should:

  • Look around to see if other people can see what is on the computer screen. Remember, your records contain your personal information. Look around
  • Keep your username and password secret. Just like your bank account PIN you would not want others to know how to get into your records.
  • Make sure you log out when you finish looking at your records so that no one else can see your personal information or change your password without your knowledge.
Shared computer
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Incorrect information in your records

Incorrect information in your records

On rare occasions information in your records might be incorrect.

  • If you find any incorrect information you should let the surgery know as soon as possible.
  • If you see information about anyone else in your records, log out immediately and let the surgery know as soon as possible.
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  • Patients under the age of 16 cannot have their own account
  • Patients over the age of 16 must have their own personal email account which cannot be shared
I am: *
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Details of the Patient
Please double check you've entered the correct email address
I wish to have access to the following online services: *
Details of the applicant(s)
 
Do you need to add a second applicant?: *
 

Should you need additional applicants, please submit another form once completing this one

Access to the the following is required on behalf of

Booking Appointments: *
Requesting Repeat Prescriptions: *
Access to Medical Records: *
Access to Test Results: *
Reason for access: *
Reason for access: *

If you are making an application on the behalf of somebody else we require evidence of your Authority

Please upload a copy your supporting documents

  • You can upload a document, photo or scan

We require evidence of your Authority or Birth Certificate

Please upload a copy your supporting documents

  • You can upload a document, photo or scan
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
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Proof of Identity
NHS Logo

Identification

We are required to check the identity of all applicants

Acceptable forms of Photo ID

  • Photo Driving License
  • Passport

ID documents are not stored and will be securely destroyed in line with our data retention schedule.

Acceptable forms of Proof of Residence

  • Tenancy agreement
  • Mortgage statement
  • Bank statement
  • Utility bill (date within the past 3 months) 

Please upload a copy of 's ID and Proof of Address

  • You can upload a document, photo or scan
Please upload a copy of your ID and Proof of Address
  • You can upload a document, photo or scan
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

Please upload a copy of 's ID and Proof of Address

  • You can upload a document, photo or scan
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

Please upload a copy of  's ID and Proof of Address

  • You can upload a document, photo or scan
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
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To be completed by the Patient

I, , give permission to my GP practice to give the following people proxy access

    

Proxy access will be given to the following online services

  • Booking appointments: 
  • Requesting repeat prescriptions: 
  • Access to my medical records: 
  • Access to test results: 
Patients requiring access to their own record
Proxy declaration

 , as the lead applicant agree the following and sign.

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Privacy Consent

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