New Patient Registration Form Child

For more information on organ donation please visit: www.organdonation.nhs.uk or ask for a leaflet on joining the NHS Organ Donor Register.

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: www.blood.co.uk or ask for a leaflet on joining the NHS Blood Donor Register

PATIENT DECLARATION for all patients who are not ordinarily resident in the UK.
Are you living permanently (ordinarily resident) in the UK?

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

Anybody in England can register with a GP practice and receive free medical care from that practice. However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. Alternatively for more information go to www.nhs.uk/visitingengland.

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate action may be taken against me.

A parent/guardian should complete the form on behalf of a child under 16.

Provide details of your Next of Kin – This is someone we can contact in the case of a medical emergency.

This section MUST be completed from your child’s Red Book or other immunisation records.

Please provide the date that these vaccines were given.

These vaccines are usually given at 8 weeks old.

Please provide the date that these vaccines were given.

These vaccines are usually given at 12 weeks old.

Please provide the date that these vaccines were given.

These vaccines are usually given at 16 weeks old.

Please provide the date that these vaccines were given.

These vaccines are usually given at 1 year old (on or after the child’s first birthday).

Please provide the date that these vaccines were given.

These vaccines are usually given at 18 months old.

Please provide the date that these vaccines were given.

These vaccines are usually given at 3 years and 4 months old or soon after).

If your child is taking regular medication, this will still need to be reviewed by our clinical pharmacist or GP before further prescriptions can be issued.

Depending on the medication, you may be contacted by the practice to provide the doctors with further information. You may be asked to make your child a medication review appointment with the GP or Pharmacist.

It is advisable to obtain a sufficient supply of your child’s normal medicines from your previous doctor to allow time for your registration application to be approved and for your child to be seen by a doctor at this practice.

We want everyone, no matter what their ethnic group, religion or culture, to be able to use our services. Providing this information helps identify some groups at greater risk of specific diseases, e.g diabetes.

All health professionals are trained to keep your records secure and to manage them responsibly and in confidence, only when related to your ongoing care.

Your GP can now see your relevant medical records which are held in other organisations that provide your care such as hospital/community clinics, hospital doctors, district nurses, or physiotherapist treating you, etc. provided you have given permission to share this information. Similarly, with your permission when they see/treat you services that you have been referred to can see the relevant aspect of your medical record.

Sharing your records benefits you because: