St Edward's Pupil Registration

 
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St Edward's School has contracted Meliora Medical Group to provide Primary Medical Care to the Pupils at the school, and they will work together with Bartlemas Surgery to provide these services.

This form asks for all the information needed from parents to register their children with the GP Surgery holding their patient records on the NHS system.

Please fill in the following form with as much detail as you can.

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Pupil's Details

Information we need to register you with the practice
Please note all fields marked with a * are mandatory for your registration

Title: *
Gender: *
  
Are you happy for us to contact you by text message? :
 
  
Parent/Guardian Contact Details
Are they your Next of Kin?: *
Do you give us permission to discuss your medical records with them?:
Previous Details
Please include postcode
Are you registering for the first time in the UK? : *
Are you returning from abroad?: *
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Identification Upload

Patient Identification

To fully register you at the practice, we need a form of Acceptable ID (if not possible, please let us know).

We will not store this document and we will securely delete / destroy it after our initial verification.

OPTIONAL: Photo of your face to add to your records to help us identify you (if you agree)

Acceptable Identification: Passport

Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
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Summary Care Record

Summary Care Record (SCR)

Your GP surgery needs permission to share important information from your GP record. This is called a Summary Care Record (SCR). Your SCR can only be shared with health and care staff across England who are providing you with direct care. It gives them access to vital information from your GP record.

Do you want important information from your GP record to be available to other health and care professionals?: *

If you do not return this form, a Summary Care Record will be created for you based on implied consent

NHS Organ Donor registration

For more information on organ donation please visit: Organ Donation

NHS Blood Donor registration

If you would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood, please visit their website on: Blood UK or call direct on 03001232323

What happens to my information?

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.

Privacy Consent

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