Summer Fields School registration form

Summer Fields School

Last Updated: 13/05/2024

  • Basic Information

    Sex
    Date Of Birth (dd/mm/yyyy)
    For example, 15 3 1984
  • Medical Records

    Please help us to trace your previous medical records by providing the following information. If you are from abroad please move to the next section

  • Medical Records (abroad)

    If you are from abroad please provide the following information:

    Date you first came to live in UK (optional)
    For example, 15 3 1984
    Signature (optional)
  • Summary Care Record

    Summary Care Record (SCR) – used nationally across England

    The SCR is a national database intended to help patient care, particularly in emergencies.  It contains registration details (name, address, date of birth, NHS number etc) and a list of prescribed medication and allergies.  It is useful for an Accident & Emergency department to check for allergies or drug interactions, to improve the treatment they can provide for you.  It is also possible to ask for a more detailed SCR containing significant diagnoses, referrals, vaccinations, care plans or other details.  Your permission will be checked each time, unless there is a special factor such as being unconscious or otherwise unable to consent.  For further information see https://digital.nhs.uk/services/summary-care-records-scr

    Your choice for Summary Care Record
  • Oxfordshire Summary Care

    The Oxfordshire Care Summary and the Out – Hours GP records sharing system

    Your patient record is held securely and confidentially on an electronic system controlled by your GP Surgery.  Your information can be viewed if you need treatment in another NHS healthcare setting, such as an Emergency Department, Out of Hours, GP, Minor Injury Unit or College Nurse (if applicable).  The professionals treating you can give you safer care if medical information from your GP Surgery is available to them.  In all these cases, your information will be viewed only by authorised healthcare professionals directly involved in your care.  You will be asked permission before the information is accessed unless the health professional is unable to ask you and there is an important clinical reason for accessing it.

    Please select one option below
  • Important

    It is important to complete this information as your new practice cannot make a decision for you. Without your direction, we cannot guarantee that your wishes will be met, even if you have previously made a similar choice in another practice. If the person signing below is not the patient, please also enter the signatory’s name and relationship to the patient, e.g. PARENT, GUARDIAN, ATTORNEY

  • Ethnicity & Language

    Do you need an interpreter or sign language support? (optional)
    What is your Ethnic Group
  • Medical Information

  • Routine childhood immunisations

    Usually given around 2 months

    1st DTAP/IPV/HIB (diphtheria, tetanus, pertussis, polio and HIB) (optional)
    For example, 15 3 1984
    Hepatitis B (optional)
    For example, 15 3 1984
    Men B (meningococcal B) (optional)
    For example, 15 3 1984
    Rotavirus (optional)
    For example, 15 3 1984
    PCV (pneumococcal) (optional)
    For example, 15 3 1984
  • Routine childhood immunisations

    Usually given around 3 months

    2nd DTAP/IPV/HIB (diphtheria, tetanus, pertussis, polio and HIB) (optional)
    For example, 15 3 1984
    PCV (pneumococcal) (optional)
    For example, 15 3 1984
    Hepatitis B (optional)
    For example, 15 3 1984
    Rotavirus (optional)
    For example, 15 3 1984
  • Routine childhood immunisations

    Usually given around 4 months 

    3rd DTAP/IPV/HIB (diphtheria, tetanus, pertussis, polio and HIB) (optional)
    For example, 15 3 1984
    Hepatitis B (optional)
    For example, 15 3 1984
    Men B (meningococcal B) (optional)
    For example, 15 3 1984
    PCV (pneumococcal) (optional)
    For example, 15 3 1984
  • Routine childhood immunisations

    Usually given around 12 - 13 months 

    HIB/MEN C (optional)
    For example, 15 3 1984
    1st MMR (measles, mumps and rubella) (optional)
    For example, 15 3 1984
    PCV (pneumococcal booster) (optional)
    For example, 15 3 1984
    Men B (meningococcal B) (optional)
    For example, 15 3 1984
  • Routine childhood immunisations

    2nd MMR (measles, mumps and rubella) (optional)
    For example, 15 3 1984
  • Routine childhood immunisations

    Usually given around 3yrs 4 months

    4th pre school booster DTAP/IPV (diphtheria, tetanus, pertussis and polio) (optional)
    For example, 15 3 1984
  • Non-routine vaccines

    BCG (optional)
    For example, 15 3 1984
    Meningitis C (optional)
    For example, 15 3 1984
    HIB Booster (Haemophilus Influenza B) (optional)
    For example, 15 3 1984
  • Signature

    Relationship to patient
  • Thank you

    Thank you for completing this registration form. When your form is complete please press the submit button. Your registration form will be sent to the Practice.

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