Consent to Sharing data on SystmOne

Please complete this form to confirm your consent to share your data on our SystmOne GP Clinical System after reading the SCR and S1 Sharing Patient Information leaflet>>

Last Updated: 04/10/2024

Your Details

Name *

Date of Birth (DD/MM/YYYY) *

Mobile Number *

Email Address *

Your patient record on SystmOne may contain information from different health and social care organisations such as a hospital, a minor injuries unit, or from a community care service such as district nursing. By providng us with your preferred mobile phone number or email address, which we will record on your medical record, when another organisation asks to access your record, we can send you a verification (security code) which allows you to choose whether to let that organisation view your medical record or not. *

I agree to sharing my data on SystmOne for my direct care

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

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Consent to Sharing data on SystmOne

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