Data Protection Policy

IMPORTANT – Use of your Data

You will be asked to complete the form below during your first visit to the clinic. It highlights the options available and helps you decide how you would like your data to be handled and stored.

Your personal information is important and will only used appropriately as part of your care and with your consent.

We use the minimum identifiable parameters and only share images and reports with your general practitioner or other healthcare provider with your permission.

Name ………………………………..

DoB ……../……../…………

House name/number+postcode …………………..

Data and images are encrypted and stored on a secure server, normally for 7 years.

We have a legal duty to conform with agreed local standards.

Please indicate below how you wish us to manage your data:

I request that my reports are shared with my G.P. (give GP name/practice………….…..) Yes/No

I request that my images and reports are available to be shared with Nobles Hospital Yes/No

I request that my images are stored on an encrypted server for up 7 years Yes/No

(*or other time as specified……………)

I would like a personal copy of my reports as:

email (email address………………………………………..….) Yes/No

paper copy (postal address……………………………………..) Yes/No

OR

I do not wish any of my data to be stored.

Signed………………………….

Print…………………………….

Dated…………………………..