Online Access for Proxy

Proxy access is where someone is given access to another person’s medical record.

The proxy does not have to be a registered patient at the practice, but must be registered for online services on the GP system and must always use their own login credentials.

To be given proxy access, a patient’s representative must have the informed consent of the patient or, in cases where the patient does not have the capacity to consent, the GP has decided that it is in the best interest of the patient for them to have proxy access.

Online Access for Proxy
Note: If the patient does not have the capacity to consent to grant proxy access and proxy access is considered by the practice to be in the patient's best interest, section 1 of this form may be omitted.

Section 1

I give permission to my GP practice to give the following people proxy access to the online services as indicated below in section 2.

I reserve the right to reverse any decision I make in granting proxy access at any time.
I understand the risks of allowing someone else to have access to my health records.
I have read and understand the information provided by the practice.

Section 2

Proxy access required

Section 3

I/we wish to have online access to the services ticked in the box above in section 2.

I/we understand my/our responsibility for safeguarding sensitive medical information and I/we understand and agree with each of the following statements *

Patient Details

(This is the person whose records are being accessed)

Representative Details

(These are the people seeking proxy access to the patient's online records, appointments or repeat prescription)