Werneth Medical Practice

76A Windsor Road, Coppice, Oldham OL8 4AL

Current time is 09:03 - We're open

Telephone: (0161) 620 5677

Fax: (0161) 620 5679

Out of Hours: 111

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ShareforYou Opt Out

You are here:
Home
/
ShareforYou Opt Out

ShareforYou Opt Out

Request for my clinical information to be withheld from the ShareforYou Record.

If you do not wish for your clinical information to be uploaded to your ShareforYou record then please complete the form below and return to your GP Practice.

If you are completing this form on behalf of another person or child, and are authorised to do so, their GP Practice will consider this request (confirming details with the patient’s medical record).

What it means if you do not have a ShareForYou Record:

NHS Healthcare Staff caring for you may not be aware of the content of your current medical record in order to treat you safely in an emergency.

ShareforYou has been introduced to patients by Oldham CCG, part of the Oldham Cares family.

Patients Name*
First Last
Address*
Telephone*
Date of Birth*
Date Format: DD slash MM slash YYYY
NHS Number (if known)
Relationship to patient (if required)*
If completing this form on behalf of somebody else
Your Name*
Signature
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