Online Services Registration

Welcome to acornsurgery

To register for online services please ensure that you complete all required fields. This form can take up to 10 minutes to complete.

If you would like any help with completing this form please visit the surgery. Paper versions of these registration documents are available on request.

Registrations may take up to 5 days to be processed.

"*" indicates required fields

Please choose from the following*

Title*

Mrs

Miss

Other

Name*

First names Surname

Date of Birth*

NHS Number (if known) Optional

Find your NHS number

Address*

Street Address Address Line 2 Town/City Postcode

Main Contact Number*

Alternative Contact Number Optional

Email Optional

Preferred method of contact*

Please provide a mobile telephone number wherever possible. By doing so, you will be automatically enrolled to our text reminder service.
We will use this for: contacting you about your health when unable to contact you at home / texting your appointment reminders / responding to your queries / advising when your prescriptions/paperwork is ready / advising you if appointments are cancelled.

What is your main language?*

Prescription / Vaccination Information

Photo/Scan of Prescription Information Optional

Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB.

Please provide evidence of your repeat medication (the boxes or repeat slip). This will allow us to add your medications to your record ready for when you need them.

Photo/Scan of Vaccination History Optional

Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB.

Please provide evidence of vaccination history . This is especially important for children.

Verifying Your ID

To help us verify your ID, please choose 2 DIFFERENT questions to answer.

Question 1*

Answer 1*

Question 2*

Answer 2*

Online Access

You can now use the internet to manage appointments, request repeat prescriptions for any medications you take regularly, check test results and look at your medical record online.

Being able to see your record online helps you to manage your medical conditions. It also means that you can access it from anywhere in the world should you require medical treatment on holiday.

The service is open 24/7/365 and can be accessed from your home PC, Tablet or Mobile phone

More information on our online services can be found here.

You can opt out of this service by contacting the practice.

Accessing your GP-held records via the NHS app or NHS website

As your GP practice, we have been asked to provide you with, no later than 31 October 2023, access to your full medical record going forward via the NHS app (and NHS website) if you have a suitable NHS login.

The purpose of the form is to specify your level of access and to ensure your understanding and agreement of your responsibilities and the risks associated with online access.

You can read our Access to Records policy here.

I wish to have access to the following online services (please tick all that apply):*

Detailed Coded Record

Full Perspective Record

I do not want any of these

I wish to access my medical record online and understand and agree with each statement (tick)*

I agree to my GP Practice giving me access to my record online*

I agree

I have read and understood the patient guide about online access to medical records and test results practice*

I agree

I will be responsible for the security of the information that I see or download*

I agree

I agree to use the system in a responsible manner. If not access may be withdrawn.*

I agree

If I choose to share my information with anyone else, this is at my own risk*

I agree

I agree that it is my responsibility to keep my username and password secure. If I think these have been shared inappropriately, I will reset them using the instructions supplied. I am also responsible for keeping safe any information I may print from the record.*

I agree

If I suspect that my account has been accessed by someone without my agreement, I will contact the practice as soon as possible*

I agree

If I see information in my record that is not about me immediately log out and report the matter to the Practice as soon as possible.*

I agree

If I think that I may come under pressure to give access to someone else unwillingly I will contact the practice as soon as possible.*

I agree

I understand that online access is granted at the discretion of the Practice, taking into account my best interests. I will be informed of any decision not to provide access or withdraw access. Please note, this does not affect your rights of Subject Access under the Data Protection Act.*

I agree

I agree that my details below may be used to contact me about how useful I find the service and whether it could be improved*

I agree

The Practice makes every effort to record information as accurately as possible, however, there may be information that you do not feel is correct.

If I notice any inaccuracies with my record, I will inform the Practice as soon as possible of any errors or omissions.*

I agree

I understand that I may see information on my record that I was unaware of or have forgotten about that could cause me distress.*

I agree

I agree to use the system in a responsible manner in accordance with all instructions given to me by the Practice. If not access may be withdrawn.*

I agree

I understand that, I will be informed by the Practice of any test results that require action. However, I understand that I may see these results online before the Practice has been able to contact me. This could be while the Surgery is closed and there is no one available to discuss with me.*

I agree

I understand that if I may see information in documents that relates to significant diagnosis before my GP or hospital specialist has the opportunity to discuss my diagnosis, prognosis and treatment options with me and that this could cause me distress.*

I agree

I understand that there may be medical terminology used within my records that I do not understand and that it will take time to arrange for a member of the team to be able to explain the relevant terminology with me and that this could cause me distress.*

I agree

Summary Care Record

There are strict laws and regulations to ensure that your health records are kept confidential and can only be accessed by health professionals directly involved in your care. There is some sharing of information as detailed below. You can opt out of any of these at any time if you wish.

NHS Summary Care Record (SCR) – this is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had. Having this information stored in one place makes it easier for healthcare staff to treat you in an emergency, or when your GP practice is closed.

If you need more time to make your choice you should let your GP Practice know.

For more information talk to the Patient Experience Team on 0800 2792535 or [email protected], visit the Cambridgeshire & Peterborough Integrated Care System website, telephone the dedicated NHS Summary Care Record Information Line on 0300 123 3020, or visit their website, or contact your GP practice staff.

You can choose not to have a Summary Care Record and you can change your mind at any time by informing staff at acornsurgery.

If you do nothing we will assume that you are happy with these changes and create a Summary Care Record for you.

I agree to opt in or opt out*

Opt-Out

What does it mean if I DO NOT have a Summary Care Record?

NHS healthcare staff caring for you may not be aware of your current medications, allergies you suffer from and any bad reactions to medicines you have had, in order to treat you safely in an emergency.

Your records will stay as they are now with information being shared by letter, email, fax or phone.

If you have any questions, or if you want to discuss your choices, you can:
– Phone the Summary Care Record Information Line on 0300 123 3020
– Contact your GP practice
– Visit www.digital.nhs.uk/scr

You can change your mind at any time.

I wish to OPT-OUT and DO NOT want a Summary Care Record Optional

Your Data

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.*

Tick this box to confirm

Comments Optional

This field is for validation purposes and should be left unchanged.