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3rd Party Confidentiality & Consent

Whilst it is vital for the proper care of individuals that detailed records are kept of their medical history and that those concerned with their care have ready access to this information, it is also important that patients can trust that personal information will be kept confidential and that their privacy is respected.

All staff have an obligation to safeguard the confidentiality of personal information. This is governed by law, contracts of employment and, in many cases, professional codes of conduct. A statement of duty of confidentiality is signed by all staff who have access to personal information whilst at the Practice.

If you wish to allow a third party i.e. family member etc discuss your medical record or documents etc. please complete the below 3rd party confidentiality & consent form – this will then be scanned onto your medical record & noted by our staff. You can withdraw consent at any time by notifying the surgery. Please ensure you state fully who can be involved & to what extent.

3rd Party Confidentiality & Consent

Patient’s Details

Patient’s Consent

I fully consent to my Parsonage Surgery releasing information to, and discussing my care / medical records with the person named below.

This authority is for *

3rd Party’s Details

Patient’s Signature

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.