Register for online services on behalf of someone else (Proxy Access)

If you are managing the health of another, you can apply for proxy access. This provides access to the person's online account for:

book and view appointments
order medication
access to medical records

Proxy access on behalf of children

People with parental responsibility for children have rights to access their children’s records. This is in most cases. Not all parents have parental responsibility. Proxy access for parent and guardian to a child’s record is a practice-level decision.

Proxy access on behalf of another adult

A person must be registered for online access at the practice where the patient they are acting for is registered. Proxy is the recommended alternative to sharing login details.

More Information

RCGP guidance on Proxy Access

NHS App: Using linked profiles to access services for someone else

Online Form To Request Proxy Access

You can complete the form below to request this. Please Note: If the patient does not have 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.

For verification purposes, to complete your registration you will need to provide the practice with two forms of identification. One form of photo ID (passport, driving licence) and one from of proof of address (utility bill, bank statement).

Section 1 (to be completed by the patient)

I give permission to my GP practice to give proxy access to the online services (as indicated below in Section 2) to the individuals named below

Name of individuals to receive access:

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 online access patient information above provided by the practice.

Date

Section 2 (to be completed by the patient)

I wish them to have access to:

Online appointments booking

Online prescription management

Access the medical record for the patient named in Section 4

Section 3 (to be completed by the representatives)

I/we wish to have online access to the services ticked in the box above in Section 2 for the patient named in Section 4.

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

I/we have read and understood the online access patient information above provided by the practice and agree that I/we will treat the patient information as confidential

I/we will be responsible for the security of the information that I/we see or download

I/we will contact the practice as soon as possible if I/we suspect that the account has been accessed by someone without my/our agreement

If I/we see information in the record that is not about the patient, or is inaccurate, I/we will contact the practice as soon as possible. I/we will treat any information which is not about the patient as being strictly confidential

Date

Section 4 The Patient – (This is the person whose records are being accessed)

First Name

Last Name

Date of birthDD/MM/YYYY

Address

Post Code

Phone Number

The Representatives – (These are the people seeking proxy access to the patient’s online records, appointments or repeat prescription).

Representative 1

First Name

Surname

Date of birthDD/MM/YYYY

Address

Post Code

Telephone

Relationship to patient

Representative 2

First Name

Surname

Date of birthDD/MM/YYYY

Address

Post Code

Telephone

Relationship to patient

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.

I consent to my information being used for the purposes described above and wish to submit this online form to Ongar Health Centre • Ongar War Memorial Medical, Fyfield Road, Ongar, Essex, CM5 0AL.

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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