testing

New Patient registration (new)

Please help us trace your previous medical records by providing the following information

If you are from abroad

If you are returning from the Armed Forces

Supplementary Questions

Ordinarily Resident

European Economic Area (EEA) Country

EHIC/PRC

S1 Form

How will your EHIC/PRC/S1 data be used?

If you are applying on behalf of a child who is in foster care/residential care/Kinship care/or who is not your child

If you are the parent/guardian/foster carer but cannot consent please detail below who can:

Data Sharing

The SCR is a summary of your medical history that can be shared between healthcare staff treating patients in an emergency or out-of-hours with faster access to key clinical information. More information can be found by visiting digital.nhs.uk.

If you were previously in the Armed Forces please complete this section:

Carer Details

Next of Kin

Medical Details

Rutland Stop Smoking Service: 01572 725805 www.rutlandrap.org.uk

Looked after Children

(please note you have a duty to notify social care of this arrangement)

Social and Language

Please provide information below if known

(Minors under 16 years old, adults lacking capacity)
On-line services

If there are any problems with your registration we will contact you to clarify any issues, but once your details have been entered into our computerised records you will be able to register with our on-line service provider (System One) and access appointments, prescriptions and some sections of your own medical record via the internet. All of the details that you need for this are available on our practice website on the online services page accessible from the home page.

New Patient Health-check

You may be eligible for a new patient health-check with a Practice Nurse/Health Care Assistant if you are on long term medication. Contact reception if you would like to take this up (Recommended).

Thank you for providing this information. We look forward to providing you with a high standard of care in a friendly and professional manner.

NSH Organ Donor registration

NHS Blood Donor registration

To be completed by the Doctor

Sending