Get Opt Out Form 1 V2 170409 - The Summary Care Record

This guide is designed to help users understand how to accurately complete the Opt Out Form 1 V2 170409 for the Summary Care Record online. By following the outlined steps, individuals can ensure their preferences regarding their clinical data are communicated clearly.

Follow the steps to fill out the Opt Out Form effectively.

1. Click the ‘Get Form’ button to access the Opt Out Form. This will allow you to open the document and begin filling it out.
2. In the title section, enter your title, such as Mr., Mrs., Ms., or Dr. using BLOCK CAPITALS.
3. In the surname or family name field, write your last name in BLOCK CAPITALS.
4. For the forename(s), provide your first name(s) in BLOCK CAPITALS.
5. Fill in your address in the designated field, ensuring that you write in BLOCK CAPITALS to maintain clarity.
6. Complete the postcode section accurately, as this helps in identifying your location.
7. In the telephone number field, provide a contact number where you can be reached.
8. Enter your date of birth in the specified format to ensure proper identification.
9. If you know your NHS number, include it in the appropriate section. This may assist in processing your request.
10. Review the notes explaining the implications of not having a Summary Care Record, ensuring you understand the potential impact on your healthcare.
11. Sign the form at the designated signature section, confirming your request to opt out.
12. Finally, note the area for the practice to action your request and ensure all details are correct before submission.
13. Once completed, you can save the changes, download, print, or share the form as necessary.

Complete the Opt Out Form online to ensure your preferences regarding your clinical data are respected.