Request Proxy Access - The Brow Health Centre

Non-urgent advice: Consent to Proxy Access to GP Online Services

If the patient does not have capacity to consent to grant proxy access and proxy access is considered by the practice to be in the patient’s best interest section 1 of this form may be omitted.

Step 1 of 3

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Section 1

Do you give permission for your GP practice to provide proxy access to online services to the following person?

Yes

Please provide the name(s) of the person(s) and their relationship to you.

Name

First Last

Date of birth

Day

Month

Year

Relationship to you

Would you like to give permission for your GP practice to provide proxy access to online services to another person?

Yes

Name

First Last

Date of Birth

Day

Month

Year

Relationship to you

I hereby specify the proxy access permissions I am granting below.Please confirm which services your proxy can see.

Online appointments booking

Online prescription management

Accessing the medical record from the date of application

Viewing my results, allergies, medication, immunisations and medical problems

Viewing my doctors’ (and other clinicians’) detailed consultation notes – please read through the information at end of this form

Consent

– I reserve the right to reverse any decision I make in granting proxy access at any time.
– I understand the risks of allowing someone else to have access to my health records.

I agree with the above statements

Confirmation

I have read and understand the information leaflet provided by the practice.

Section 2

Please confirm your understanding and agreement with the following statements regarding the safeguarding of sensitive medical information.

Do you (or your representatives) wish to have online access to the services selected in Section 1 for the patient named above?

I/we have read and understood the information leaflet provided by the practice and agree that I will treat the patient information as confidential.

I/we will be responsible for the security of the information that I/we see or download.

I/we will contact the practice as soon as possible if I/we suspect that the account has been accessed by someone without my/our agreement.

If I/we see information in the record that is not about the patient, or is inaccurate, I/we will contact the practice as soon as possible. I/we will treat any information which is not about the patient as being strictly confidential.

Please upload proof of ID (showing current address and date of birth) to register for Patient Access.We accepted the following forms of ID: driving license, passport, citizen ID cards, birth certificate. We cannot register you without it. Family members have to use unique email addresses for each person, even children.

Max. file size: 1 GB.

Section 3

The Patient

This is the person whose records are being accessed.

Name

First Last

Date

Day

Month

Year

Address

Street Address Address Line 2 City postcode

Email address

Enter Email Confirm Email

Mobile Number

Telephone Number Optional

The Representatives

These are the people seeking proxy access to the patient’s online records, appointments or repeat prescription.

Name

First Last

Date of birth

Month

Day

Year

Gender

Male

Female

Address

Street Address Address Line 2 City Postcode

Enter Email Confirm Email

Mobile Number

Telephone Number Optional

Relationship to patient

Do you wish to add another representative?

Yes

Name

First Last

Date of birth

Month

Day

Year

Gender

Male

Female

Address

Street Address Address Line 2 City Postcode

Enter Email Confirm Email

Mobile Number

Telephone Number Optional

Relationship to patient

Proxy Consent for Patient Access (GP Online Services)

Proxy access allows parents, family members, carers, care home staff, to have access to their patients’/dependants’ online services accounts, in order to book appointments, request repeat medication and where applicable, view their medical record.

Anyone with capacity to do so may give informed consent to the practice to give proxy access to online services and the GP records. If the patient lacks capacity, proxy access may be given to a family member or carer either because they hold a Power of Attorney for health and welfare or because the GP judges it to be in the patient’s best interests.

The proxy does not have to be a registered patient at the practice, BUT must be registered for online services on the GP system and always use their own login credentials. They should not have access to the patient’s login credentials.

The practice can refuse or withdraw proxy access, if they judge that it is in the patient’s best interests to do so.

The level of access is configured per patient for each proxy user, as they may care for more than one patient and need different levels of access.

Applying for Proxy Access

If you wish to apply for proxy access (essential for children under the age of 16 years) you must complete the Proxy Access form (available from reception). The form is split into the following Sections:

1. the ‘patient’ gives permission for the named ‘representative’ to have proxy access and the level of access being given. The patient must sign.

2. the ‘representative’ requests access to the ‘patient’s’ online access and signs to understand their responsibility for safeguarding sensitive information. The ‘representative’ must sign.

3. this gives details (name, address, date of birth, contact details) for both the ‘patient’ and ‘representative’.

Patient Online Access

You can now use the internet to book appointments with a nurse or for a blood test, request repeat prescriptions for any medications you take regularly and look at the results of your blood tests or your immunisation records online. You can also still use the telephone or call in to the surgery for any of these services as well. It is your choice.

Being able to see your results online might help you to manage your medical conditions. It also means that you can even access them from anywhere in the world should you require medical treatment on holiday.

From October 2023, patients and their proxies can now have digital access to their clinicians’ consultation notes (please note, this will be from the date of request rather than retrospective access).

Whether you decide to have access or not, or if you change your mind at any time, this is your choice and practice staff will continue to treat you in the same way as before. This decision will not affect the quality of your care.

You will be given login details, so you will need to think of a password, which is unique to you. This will ensure that only you are able to access your record – unless you choose to share your details with a family member or carer.

The practice may not be able to offer online access due to a number of reasons such as concerns that it could cause harm to physical or mental health or where there is a reference to third parties.

The practice has the right to remove online access to services for anyone they feel it could harm or put at risk.

It will be your responsibility to keep your login details and password safe and secure. If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately.

If you cannot do this for some reason, we recommend that you contact the practice so that they can remove online access until you are able to reset your password.

If you print out any information from your record, it is also your responsibility to keep this secure. If you are at all worried about keeping printed copies safe, we recommend that you do not make copies at all.

Patients can now apply to have access to their contemporaneous medical notes. Access will be prospective, i.e. from the date of application. There are some important things to consider before deciding to apply for this:

Forgotten history

There may be something you have forgotten about in your consultation notes or other parts of your medical record which you may find upsetting, or indeed, traumatising, to revisit. This may also apply to your proxies if you give them access to your consultation notes.

Abnormal results

If you have been given access to test results, you or your proxy/proxies may see something that you find upsetting – for example, test results revealing new and serious diagnoses such as cancer. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them.

Choosing to share your information with someone

It’s up to you whether or not you share your information with others – perhaps family members or carers. You may prefer your proxy/proxies to have access to some parts of your records but not others.

Coercion

If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time.

Misunderstood information

Your medical record is designed to be used by clinical professionals to communicate with each other, rather than directly to patients. Much of the information will be written in technical language and will not be easily understood by lay people.

Information about someone else

If you or your proxy/proxies spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible.

More information

For more information about keeping your healthcare records safe and secure, you will find a helpful leaflet produced by the NHS in conjunction with the British Computer Society:

Keeping your online health and social care records safe and secure

Consent

I have read and understood the above

I wish for my proxy to have access to my consultation notes

I do not wish for my proxy to have access to my consultation notes

Comments Optional

This field is for validation purposes and should be left unchanged.