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PATIENT REGISTRATION FORM

Patient consent for processing of health data.

To assist with your care, we at Docpoint need to collect personal data about you. This information will include details of your health and your treatments.

We may also need to record additional information that while may not seem to relate directly to your health it would help in our treatment of you. Examples of this kind of information would include things like your age, gender, marital status, number of children you have, your nationality, your employment status, religion, prison sentences. Our policy is only to collect and record information about you that helps in your treatment.

Declaration:

PATIENT REGISTRATION FORM

Patient consent for processing of health data.
To assist with your care, we at Docpoint need to collect personal data about you. This information will include details of your health and your treatments.

We may also need to record additional information that while may not seem to relate directly to your health it would help in our treatment of you. Examples of this kind of information would include things like your age, gender, marital status, number of children you have, your nationality, your employment status, religion, prison sentences. Our policy is only to collect and record information about you that helps in your treatment.

Declaration:

• I understand my health information will be seen or shared only with medical and administrative staff involved in my care or where Docpoint is required to do so by law.

• I understand that for the purposes of my treatment administrative staff may have to access my health data.

• I understand that all Docpoint staff sign a confidentiality agreement that binds them not to disclose my details to any unauthorised persons not involved in my care.

• I understand that any health data shared outside of the practice for the purposes of my health treatment will normally be limited to information related to a particular treatment and not my entire file.

• I understand that my health data will be stored primarily on a secure database operated by a specialist company.

• I understand that Docpoint will only release information at my express request.

• I understand that I can withdraw consent for processing of my personal health data at any time.

I hereby freely consent for Docpoint to process my personal data, including health information, for the purpose of my on-going health care treatment in accordance with what I understand above.
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