• Skip To Content
  • Select Language
    • Afrikaans
    • Albanian
    • Arabic
    • Armenian
    • Azerbaijani
    • Basque
    • Belarusian
    • Bengali
    • Bulgarian
    • Catalan
    • Chinese (Simplified)
    • Chinese (Traditional)
    • Croatian
    • Czech
    • Danish
    • Dutch
    • Esperanto
    • Estonian
    • Filipino
    • Finnish
    • French
    • Galician
    • Georgian
    • German
    • Greek
    • Gujarati
    • Haitian Creole
    • Hebrew
    • Hindi
    • Hungarian
    • Icelandic
    • Indonesian
    • Irish
    • Italian
    • Japanese
    • Kannada
    • Korean
    • Lao
    • Latin
    • Latvian
    • Lithuanian
    • Macedonian
    • Malay
    • Maltese
    • Norwegian
    • Persian
    • Polish
    • Portuguese
    • Romanian
    • Russian
    • Serbian
    • Slovak
    • Slovenian
    • Spanish
    • Swahili
    • Swedish
    • Tamil
    • Telugu
    • Thai
    • Turkish
    • Ukrainian
    • Urdu
    • Vietnamese
    • Welsh
    • Yiddish
  • Facebook
  • Font Size
    • Increase Font Size
    • Decrease Font Size
    • Reset Font Size
Longford Primary Care Centre - Dr Princewill & Partners
Search
Show Main Menu
  • Home
  • Practice Information
    • About The Practice
    • Comments & Complaints
    • Confidentiality
    • Doctors and Staff
    • Extended Hours - Opening Times
    • Facilities
    • GDPR
    • GDPR Privacy Notices
    • Get help in an emergency
    • Integrated Care Record
    • Patient Advice and Liason Service
    • Patient Participation Group
    • Policies
    • Surgery Times
  • Services
    • Access my medical records
    • Appointments
    • Blood Tests & Test Results
    • Clinics
    • Drugs & Alcohol Service
    • First Contact Physiotherapy
    • Home Visits
    • Non-NHS Services & Fees
    • Obtain a Fitness for Work note
    • Prescriptions
    • Register with the practice
    • Register as a carer
    • Telephone Consultations
    • Travel Information
    • Vaccinations
  • Health Advice
    • Bereavement
    • Health A - Z (Symptom Checker)
    • Cervical Cytology
    • Depression
    • Health & Social Care
    • Keep Healthy & Live Well
    • Leaflets
    • Sexual Health Advice & Termination Advice
  • News
  • Contact Us
    • Contact Details
    • Friends & Family Test
  • Online Services
    • NHS App
    • Patient Online Access
  • Covid-19
Show Side Menu
Patient Online Access
NHS App
Domestic Violence
Coventry Foodbank
Welcome to Coventry
Follow us on Facebook
Find Your NHS Number
  • Alcohol Audit C
  • Allergies
  • Carer Questionnaire
  • Depression Questionnaire (PHQ9)
  • Feedback for the Practice
  • Health Review
  • Health Review for patients with a learning disability
  • Join Patient Reference Group
  • Long Term Conditions
  • Medication Review
  • Question for the Practice
  • Repeat Prescription
  • Smoking Status
  • Summary Care Record Opt-Out
  • Update Your Contact Details
Call 111 - When it is less urgent than 999
BBC Health News
  • NHS: More at-home care offered in attempt to shorten waiting times29 Jan 2023 02:18Boosting care in the community is identified as being key to help the health service's recovery.
  • The Last of Us: Could a fungal pandemic turn us all into zombies?28 Jan 2023 00:07The apocalyptic plot of hit TV series The Last of Us has coincided with a real-life threat from fungi.
  • Toxic slimming pill drug DNP to be declared poison27 Jan 2023 20:38Families say the government has not acted quickly enough to prevent deaths from diet drug DNP.
  • Wynter Andrews: NHS trust fined £800k over baby's neglect death27 Jan 2023 15:45Wynter Andrews' parents Gary and Sarah say the fine "demonstrates the seriousness" of the failings.
  • US to make it easier for gay men to donate blood27 Jan 2023 21:10The FDA will soon remove a three month abstinence policy for donations for men who have sex with men.
  • Shop loyalty card data may help spot ovarian cancer27 Jan 2023 00:07Shoppers' purchases of medicines could flag early symptoms linked to the cancer, UK researchers say.

Carer Questionnaire

Do you look after someone?

Does someone look after you?

A Carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.

If you are a Carer, or you have a Carer, it is important that you inform the surgery so we can update our records.

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
If Known

Patient Being Cared For (To Be Completed By The Patient)

DD/MM/YYYY
If Known
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


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.


Back to top

Site

  • Home
  • Practice Information
  • Services
  • Health Advice
  • News
  • Contact Us
  • Online Services
  • Covid-19

About

  • Sitemap
  • Disclaimer
  • Website Privacy
  • Website Accessibility
  • Cookies
  • Content Attribution
  • Back To Top

Social

  • Facebook

Contact

Longford Primary Care Centre - Dr Princewill & Partners

Longford Road, Longford, Coventry, West Midlands, CV6 6DR

  • 0333 332 3888
  • lpcc.bghc@nhs.net

Bell Green Health Centre

Roseberry Avenue, Bell Green, Coventry, West Midlands, CV2 1NE

  • 024 7668 9310
© Neighbourhood Direct Ltd  2023
Website supplied by Oldroyd Publishing Group

Loading...