Wheelers Green Way, Thatcham, Berkshire, RG19 4YF
Tel: 01635 868006, Fax: 01635 867484
Email: [email protected] Website: [email protected]
GP ONLINE SERVICES
Save time – do it online!
BOOK
GP & NURSE
APPOINTMENTS
ORDER
REPEAT
PRESCRIPTIONS
VIEW YOUR
MEDICAL
RECORDS

GP online services gives you the patient the option to book appointments, request
repeat prescriptions and view part of your GP medical records online, rather than
having to phone or visit the surgery. It is quick, easy and secure.

You will be emailed your login details, so you will need to think of a username and
password which is unique to you. This will ensure that only you are able to access
your record. It will be your responsibility to keep your login details and password safe
and secure.
ELECTRONIC
PRESCRIPTION SERVICE

We encourage our patients to use the Electronic Prescription Service (EPS). This
means that your prescriptions will go directly to a pharmacy of your choice. Using
EPS means that you no longer have to come to the surgery to pick up your repeat
prescriptions, you go straight to your nominated pharmacy.

To use the EPS service you will need to advise us of the pharmacy that you would
like your prescriptions sent to, this is called nomination. If you change your mind at
any time, you can nominate another pharmacy or revert to collecting paper
prescriptions.

Complete the application by simply choosing one pharmacy for us to send your
electronic prescriptions to on the attached form. Please note: This is where we will
send all your repeat requests to – unless you specify otherwise.
Application for GP online access
& Electronic Prescription Service
Surname:
Date of birth:
First names:
NHS number:
Address:
Postcode:
Email:
Home
telephone number:
Mobile
number:
I wish to have access to the following online services
(Please tick all that apply…)
1.
2.
3.
4.
Online booking of appointments
Online requesting of repeat prescriptions
Online access to my medical record – please also complete other side of this form
Online electronic prescription service - don’t forget to nominate below
I wish to use the Electronic Prescription Service
(Please tick one pharmacy only…)
Lloyds Pharmacy - Burdwood
The Burdwood Centre, Thatcham, RG19 4YA
Lloyds Pharmacy – Kingsland
7 Kingsland Centre, The Broadway, Thatcham, RG19 3HN
Lloyds Pharmacy – Crown Mead
3-5 Crown Mead, Thatcham, RG18 3JW
Lloyds in Sainsbury’s Pharmacy – Newbury
Sainsbury’s, Hectors Way, Newbury, RG14 5AB
Boots Pharmacy – Newbury Retail Park
Unit 13, Pinchington Lane, Newbury Retail Park, Newbury, RG14 7HU
Boots Pharmacy – Thatcham Medical Centre
Bath Road, Thatcham, RG18 3HD
Boots Pharmacy – Northbrook Street, Newbury
4-5 Northbrook Street, Newbury, RG14 1DJ
Boots Pharmacy – Bartholomew Street, Newbury
82-83 Bartholomew Street, Newbury, RG14 5EF
Tesco Pharmacy – Newbury
Pinchington Lane, Newbury, RG14 7HB
Superdrug Pharmacy
81-82 Northbrook Street, Newbury, RG14 1AE
Other Please give the full name and address of pharmacy
Do you currently have access to GP Online Services?
YES / NO
Patient Consent Form for Detailed Coded Record Access
You can now view your GP medical record online to look at test results, details of consultations and your medical
history, including current and past medication.
If you would like to have secure online access to your records, we need to make sure that you understand what this involves
and that you are happy for us to use the information about you to set up the and operate the service.
The following form will take you through the things you need to think about. By signing the form you will be giving us
your permission to go ahead with setting up the service for you. If you decide not to join, or wish to withdraw, it will
not affect your treatment in any way.
Access is granted at the discretion of the practice. Your request for access may take up to 7-10 working days to process.
You will be informed if access cannot be granted.
Declaration (please circle response as appropriate):
1. I agree to my GP practice giving me access to my record online.
2. I have been provided with information leaflet about access to GP medical records which I have
read and understood.
3. I agree to use the system in a responsible manner in accordance with all instructions given to me
by the practice. If not access may be withdrawn.
4. If I see information which does not relate to me, I will immediately log out and report the matter to
the practice as soon as possible.
5. I agree that it is my responsibility to keep my username and password secure. If I think these
have been shared inappropriately I will reset them using the instructions supplied. I am also
responsible for keeping safe any information I may print from the record.
6. I agree that my details below may be used to contact me about how useful I find the service and
whether it could be improved.
7. I understand that online access is granted at the discretion of the practice, taking into account my
best interests. I will be informed of any decision to withdraw the service. Please note, this does
not affect your rights of Subject Access under the Data Protection Act.
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
Other considerations (please circle response as appropriate):
The practice makes every effort to record information as accurately as possible, however there may be information
that you do not feel is correct.
1. If I notice any inaccuracies with my record, I will inform the practice manager as soon as
possible of any errors or omissions.
YES / NO
2. I understand that I may see information on my record that I was unaware of/have forgotten
about that could cause distress.
YES / NO
3. I understand that as before, I will be informed directly, by the practice, of any test results which
require further action. However I understand that I may see these results online before the
practice has been able to contact me. This could be while the surgery is closed and there is no
one available to discuss them with me.
YES / NO
To be signed by patient: ____________________________________________ Date: ________________________
………………………………………………………………..........................................................................................................................................................
For Surgery use only
Date completed form received from patient: ____________________
Cut-off date for authorisation (max 10 days from receipt of form):___________________
Level of record access enabled
Notes
Detailed Coded
All
Partial
GP Authorisation: ____________________________________________ Date: ________________________
Access enabled: ______________________________________________ Date: _________________________