National Data Type 1 Opt-out Form

Information about you and the care you receive is shared, in a secure system, by healthcare staff to support your treatment and care.

It is important that the NHS can use this information to plan and improve services for all patients. The NHS would like to link information from all the different places where you receive care, such as your GP, hospital and community services, to help provide a full picture. This will allow the NHS to compare the care you received in one area against the care you received in another, so the NHS can see what has worked best.

There are two levels of national data sharing of your information.

Type 1 Opt-out

The data held in your GP medical records is shared with other healthcare professionals for the purposes of your individual care. It is also shared with other organisations to support health and care planning and research.

You have a choice. If you are happy for your information to be used in this way you do not have to do anything. If you do not want your personally identifiable patient data to be shared outside of your GP practice for purposes except your own care, you can register an opt-out with your GP practice. This is known as a Type 1 Opt-out.

Type 1 Opt-outs may be discontinued in the future. If this happens then they may be turned into a National Data Opt-out. Your GP practice will tell you if this is going to happen and if you need to do anything. More information about the National Data Opt-out is here: https://www.nhs.uk/your-nhs-data-matters/

You can use this form to:

register a Type 1 Opt-out, for yourself or for a dependent (if you are the parent or legal guardian of the patient) (to Opt-out)
withdraw an existing Type 1 Opt-out, for yourself or a dependent (if you are the parent or legal guardian of the patient) if you have changed your preference (Opt-in)

This decision will not affect individual care and you can change your choice at any time, using this form.

Type 2 Opt-out

Information at NHS Digital which does not reveal your identity can then also be used by others, such as researchers and those planning health services, to make sure we provide the best care possible for everyone.

You have a choice. If you are happy for your information to be used in this way you do not have to do anything. If you have any concerns or wish to prevent this from happening, please check https://www.nhs.uk/your-nhs-data-matters/manage-your-choice/ for further information on how to make your choice. GP practices are no longer able manage this type of opt-out.

For more information on either type of opt-out click here.

Details of the patient

Title

Fore Name

Surname

Date of Birth

Contact Number

Address

NHS Number (if known)

Details of parent or legal guardian
If you are filling in this form on behalf of a dependent e.g. a child, the GP practice will first check that you have the authority to do so. Please complete the details below:

Full Name

Relationship

Address

Register your Type 1 Opt-out preference
Your decision

Opt-out : I do not allow my identifiable patient data to be shared outside of the GP practice for purposes except my own care. OR I do not allow the patient above’s identifiable patient data to be shared outside of the GP practice for purposes except their own care.

Opt-in (Withdraw Opt-out) : I do allow my identifiable patient data to be shared outside of the GP practice for purposes beyond my own care. OR I do allow the patient above’s identifiable patient data to be shared outside of the GP practice for purposes beyond their own care.

Patient declaration

I confirm that the information I have given in this form is correct.

Parent declaration

I confirm that I am the parent or legal guardian of the dependent person I am making a choice for set out above (if applicable).

Consent

I agree to being contacted via the details given above. I agree to the privacy policy.

National Data Type 1 Opt-out Form

This decision will not affect individual care and you can change your choice at any time, using this form.

Incorrect Info