Care Home Registration

 
Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)

This form is for registering care home residents only.

For all other over registrations use the New Patient Registration form.

Are you using this form to register a care home resident?: *

You are unable to continue with this form.

Are you registering this patient as a temporary or permanent resident?: *
Processing
Preliminary Questions
Is this the patient's first registration with a GP Practice in the UK?: *
Is the patient from abroad?: *
Is the patient a military veteran?: *
Does the patient need their doctor to dispense medicines and appliances?: *
Is the patient "ordinarily resident" in the UK?: *
Does the patient wish to register on the NHS Organ Donor Register?: *
Does the patient wish to register with the NHS Blood Donor Register as a blood donor?: *
Processing
Patient's Details

Information we need to register you with the practice
Please note all fields marked with a * are mandatory for your registration

Title: *
Sex: *
Previous Details
Please include postcode
Processing
Medical Information
Do they have a DNAR form?: *
Do they have a ReSPECT form?: *
Do they have an advanced directive/living will?: *
Do they have capacity?: *
Are they known to ECHO?: *
End of Life Care Hub
Any allergies or sensitivities?: *

Please check and include as much information about current medications below. If there are any MARS, patient summary from previous GP practice or a hospital discharge summary please upload these at Part 3 of the registration.

Patient Specific Information
Personal Care Activity: *
Dressing Activity: *
Eating: *
Swallowing problems: *
Continence: *
Mobility: *
Aids used: *
At risk of falls?: *
Vision: *
Glasses: *
Hearing: *
Hearing aids: *
Do you have the current height and weight for the patient?: *
Any known weight loss recently?: *
Catheter: *
Stoma: *
Self toileting?: *
Current pressure sores/ulcers?: *
Smoking: *
Memory Function: *
Behaviour: *
Processing
Sharing Your Health Records
Do they consent to their GP Practice sharing their health records with other organisations who care for them?: *

This option means that we are unable to share information with organisations such as the community nurses and proactive care which could delay care which is required.

Do they consent to their GP Practice viewing their health records from other organisations that care for them?: *
Do they consent to having an Enhanced Care Record with Additional Information?: *

Patient Declaration

For all patients who are not ordinarily residents in the UK

Anybody in England can register with a GP and receive free medical care from that practice.

However, if you are not "ordinarily resident" in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of "indefinite leave to remain" in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges. More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediate necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisation (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovering. You may be contacted on behalf of the NHS to confirm any details you have provided.

Please tick one of the following boxes:

Non resident payment options: *
A parent/guardian should complete the form on behalf of a child under 16.
European Economic Area (EEA) Country
Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?:
Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) ?:

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

Please enter the details from your EHIC or PRC below.

Additional Information
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Processing

What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

Privacy Consent

Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.

Facebook