Dissent from secondary use of GP patient identifiable data

I am writing to give notice that I refuse consent for my identifiable information/ and the identifiable information of those for whom I am responsible to be transferred from your practice systems for any purpose other than my medical care. Please take steps to ensure my / our confidential personal information is not uploaded and record my dissent by whatever means possible. I am aware of the implications of this request, understand it will not affect the care that I /we receive, and I will notify you should I change my mind.

Last Updated: 07/06/2021

Dissent from secondary use of GP patient identifiable data

Name *

Full Address and Postcode *

Date of Birth *

I am aware of the implications of this request and I would like for my medical record to be coded with "Dissent from secondary use of GP patient identifiable data" *

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Dissent from secondary use of GP patient identifiable data

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