Do you agree to the processing and sharing of Personal Data about the progress of your treatment with your nominated contact(s)?
Data Protection Consent
- In this section "Data Protection Laws" means the Data Protection Act 2018, the Privacy and Electronic Communications (EC Directive) Regulations 2003 and any other Applicable Law relating to the processing, privacy or use of Personal Data; and "Personal Data" shall have the meaning given to it in the relevant "Applicable Law" with Personal Data including sensitive Personal Data and special categories of Personal Data. "Applicable Law" shall mean all applicable statutes, regulations, orders, regulatory requirements, by laws, ordinances, rules, subordinate legislation and other laws, including any judicial or administrative interpretation of them, in force from time to time in any applicable jurisdiction.
The London General Practice (TLGP) is committed to protecting and respecting patient privacy and to complying with Data Protection Laws and medical confidentiality guidelines. We have procedures in place to ensure that your information is kept safe, and that your Personal Data are kept confidential at all times. Please tick each of the boxes below if you agree to TLGP processing and sharing your Personal Data (whether obtained by TLGP and whether obtained at TLGP or another hospital or surgery) in the way described:
Please note that you can opt out at any time from any of the data processing and data sharing initiatives described below (although this will not affect the lawfulness of any processing of your Personal Data up to that point). If you change your mind at a later date please contact us here: email@example.com
From time to time TLGP would like to inform you about new treatments, facilities, services, and offers. If you want to receive information about products and services from TLGP, please let us know by ticking the relevant boxes.
In ticking this box, you agree to the processing and sharing of Personal Data about the progress of your treatment with your health insurance company, embassies, GP, consultant and/or sponsor.
By ticking the box below, you consent to TLGP leaving voicemails containing your medical information on the phone number(s) listed on this Patient Registration Form. This information may include, but is not limited to, demographic information (patient name, date of birth, address, etc.), billing information, and medical information (appointment dates, diagnosis, medications, test results, etc.)
For your security emails sent out by TLGP containing confidential patient data (e.g. clinical information) are encrypted using Egress Software to ensure information can be exchanged securely.
By ticking the box below, you consent to TLGP contacting you by un-encrypted email. Information included in these emails may include, but is not limited to, demographic information (patient name, date of birth, address, etc.), billing information, and medical information (appointment dates, diagnosis, medications, test results, etc.).
- 1. You may be receiving care from other people as well as employees of TLGP. So that we all work together for your benefit, TLGP may need to share some information about you with those people or organisations, and they may wish to send your information to companies/individuals outside the European Economic Area to support subsequent care. Medical information will be disclosed to those involved with your treatment or care at TLGP and, if applicable, to any person or organisation or their agents or service providers within and outside the European Economic Area to carry out Service (which may include transcription of medical notes) and support your subsequent or ongoing care.
2. TLGP will share your (or where applicable, your Guarantor or Sponsor's) non-medical information in relation to billing, processing, payment or collection of accounts, or credit referencing information. This extends to any person or organisation they may involve in order to achieve this. TLGP will employ appropriate measures to protect your personal data where this is the case.
3. TLGP has regulatory and/or compliance obligations to share certain clinical data with various governmental and regulatory bodies (for example the Care Quality Commission). This may include any personally identifiable clinical information, including your NHS patient identification number or its equivalent.
- I acknowledge and understand I confirm that I have read, understood and accept the terms and conditions outlined above. I understand that I am personally responsible for any costs associated with my procedure if these costs are not covered by medical insurance, insurer or other third party such as a guarantor. I undertake to settle all personal expenses, cost of treatment at the time of my departure or upon request. I give permission to TLGP or any other health care professional involved in my care, to access health information about me that is relevant to my treatment, which may be held by TLGP, other health professionals or health organisations.
I confirm that the information I have provided in this registration form is a true reflection of my current health and past medical history.