Health Record Opt Out

If you DO NOT wish for your data to be shared please complete this form.

Health Record Opt Out

Please use this date format: DD/MM/YYYY.
If known

Conditions for opt out

If you are unsure what boxes to tick please consult with your practice staff for advice.

1) If you wish to object to the sharing of your patient identifiable data.

2) If you wish to withdraw your objection to the sharing of your patient identifiable data.

3) Consent to share de-identified or pseudonymised data with specified third parties (Apollo and MedeAnalytic) for use by local health and social care to provide a more joined up service.

Consent to option 3 can be selected along-side the type 1 and 2 objections and further details of the local schemes can be found in a leaflet from your general practice or at: www.enhertsccg.nhs.uk