Nightingale NHS data-sharing type-1 opt-out June 2021

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. You can use the form below to tell us your preferences.

Last Updated: 05/07/2021

Patient Details

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:

Register your Type 1 Opt-out preference

You decision

Your Declaration

I confirm that: • the information I have given in this form is correct • I am the parent or legal guardian of the dependent person I am making a choice for set out above (if appliable)

For GP Practice Use only