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  • 01277 367200
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Ongar Health Centre Providing NHS services
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Home > Carer Questionnaire

Carer Questionnaire

Do you look after someone?

Does someone look after you?

A Carer is anyone, including children and adults who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.

If you are a patient with us and/or you care for someone who is a patient with us it is important to have yourself registered as a carer at your GP surgery as this may enable you to have access to additional support.

You can complete our online form further down this page to tell us if you are a carer.

It is important we hold complete and up-to-date information so we can provide the best level of care possible. If your information changes, please make sure you let us know. As your GP, we treat confidentiality very seriously and will never share your information with any other organisation without your prior consent.

If you have a carer who assists with your medical needs such as ordering Medication or arranging appointments you can complete the attached consent form (DOCX, 30KB) and return it to the Practice to be added to your record.

Our PPG has been working alongside Carers First to set up a support network for our patients who are Carer’s. They are delighted to say that this has been a success so far and they have now set up a group.

Open to all Carers, anyone over 18 who is supporting an adult family member, close friend or even unpaid. There will be a support group at The Zinc Art Centre, Great Stoney, High Street, CM5 0AD. This will be the second Wednesday of every month 1.30pm to 3.30pm.

If you would like to attend, please register your interest with Carers First either via www.carersfirst.org.uk or by calling 0300 303 1555

They look forward to you joining!

Essex Wellbeing Service

Advice, information guidance on support available for you as a carer.

More information here

Essex County Council

Information, support and guidance for people who look after someone.

More information here.

NHS

Social care and support guide for carers from the NHS

Support and benefits for carers

Help for young carers

Carers Trust

Carers Trust help unpaid carers have access to the support, advice and resources.

Carers Trust

Carer services near you

Getting support if you are a young carer or young adult carer

Carers UK

They provide unpaid carers with expert information, advice and support.

www.carersuk.org

Carers Form:

It is important we hold complete and up-to-date information so we can provide the best level of care possible. If your information changes, please make sure you let us know. As your GP, we treat confidentiality very seriously and will never share your information with any other organisation without your prior consent.

Carers Personal Details (To Be Completed By The Carer)


DD/MM/YYYY
Find my NHS Number (opens in new window)

Are you registered at our surgery?
Patient Being Cared For (To Be Completed By The Patient)

DD/MM/YYYY
Find my NHS Number (opens in new window)
Is the patient registered at our surgery?
Enhanced Summary Care Record (To Be Completed By The Patient)

The Summary Care Record (SCR) is an electronic record of important patient information, created from GP medical records. It can be seen and used by authorised staff in other areas of the health and care system involved in the patient’s direct care. Access to SCR information means that care in other settings is safer, reducing the risk of prescribing errors. It also helps avoid delays to urgent care. If you are registered with a GP practice in England your SCR is created automatically, unless you have opted out.

As a minimum, the SCR holds important information about; current medication, allergies and details of any previous bad reactions to medicines, your name, address, date of birth and NHS number. We are encouraging patients to opt in to enhancing their SCR to provide other health care professionals with a better understanding of your history. Enhancing your SCR would include the following information;

  • Significant medical history (past and present)
  • Reason for medication
  • Anticipatory care information (such as information about the management of long term conditions)
  • Communication preferences
  • End of life care information and Immunisations

Do you consent to your Summary Care Record being enhanced?

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Ongar Health Centre

Ongar War Memorial Medical, Fyfield Road, Ongar, Essex, CM5 0AL

  • 01277 367200
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