Highfield Surgery

Cambrian Way, Hemel hempstead, HP2 5TA

Telephone: 01442 265322

Sorry, we're currently closed. Please call NHS 111

SCR (Summary Care Record)

SCR) patient consent form

Having read the information in the SCR section, please choose ONE of the options below. If you need any more information, you can visit wwww.digital.nhs.uk/summary-care-record/patients or call NHS digital on 0300 303 5678
Yes,- I would like a Summary Care Record
No - I would NOT like a Summary Care Record
Date of birth(Required)

Filling the form on behalf of onother person

If you are filling the form on behalf of another person, please ensure that you fill out THEIR details above; you sign the form above and provide your details below:
ParentLegal GuardianLasting Power of Attorney for Health and Welfare

For GP Practice use ONLY

The patient wants a core Summary Care Record (express consent for medication, allergies and adverse reactions only) 9Ndm / XaXbYThe patient wants a Summary Care Record with core and additional information(express consent for medication, allergies and adverse reactions and additional information) 9Ndn / XaXbZThe patient does not want to have a Summary Care Record (express dissent for Summary Care Record - opt out) 9Ndo / XaXj6
This field is for validation purposes and should be left unchanged.

Opening Times

  • Monday
    08:00am to 06:30pm
  • Tuesday
    08:00am to 06:30pm
  • Wednesday
    08:00am to 06:30pm
  • Thursday
    08:00am to 06:30pm
  • Friday
    08:00am to 06:30pm
  • Saturday
  • Sunday
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