Registering New Baby

Please complete this form to register a new baby with the surgery.

Last Updated: 27/08/2021

Child's Details

Parent/ Guardian

If details differ from above, please complete this section.

Name

Address

Telephone number

Sharing OUT

This controls whether your child's full GP electronic patient record can be shared with other NHS Care Services where they are treated.

Please record your preference *

Sharing Out Yes (shared)

Sharing Out No (Not shared)

Sharing IN

This controls whether you agree for this practice to view your child's information that has been shared at other NHS Services.

Please record your preference *

Sharing In Yes (viewable)

Sharing In No (not viewable)

Further Consent

There may be occasions where in an emergency other healthcare providers may need to view parts of your child's medical record, for example the A&E department, ambulance service etc.

DO YOU CONSENT TO HAVING A SUMMARY CARE RECORD? (ELECTRONIC RECORD WHICH CONTAINS INFO ABOUT MEDICATION, ALLERGIES, SENSITIVITIES AND PAST MEDICAL HISTORY TO MAKE IT EASIER FOR ALL HEALTHCARE STAFF TO TREAT YOU IN AN emergency) *

Yes No

DO YOU CONSENT TO HAVING AN ENHANCED SUMMARY CARE RECORD? (AS ABOVE WITH ADDITIONAL INFORMATION) *

Yes No

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the The Waterloo Practice website

Registering New Baby

Further Information