Right to object form

This opt-out form is solely for the purposes of the Population Health programme (HealtheIntent).

Choosing to object won’t affect how you access any clinical services - you will continue to receive health and care when you need it. If you object, we will ensure that your health and care data is not included as part of this programme.

To object you will need:

to be aged 16 or over, and
your NHS number. Your NHS number is a 10-digit number, eg 943 476 5919. You can find this on any letter sent to you by the NHS, on a prescription, or by logging in to a GP practice online service.

Parents or legal guardians may object on behalf of children under the age of 16.

If you have legal authority to do so (e.g. a power of attorney) you may object on behalf of another person, or opt back in on their behalf. We may ask you for written proof of such an authority.

Right to Object form

First Name *

Surname *

Email Address *

Confirm Email Address *

Address *

Postcode

Date of birth *

NHS number *

Objecting

If you still want to object, please complete the information in the form above, tick the boxes below to show you agree with the statements, and press the ‘I wish to object’ button.

If you prefer, you can use a form that you can post or email to us instead. Details of how to do this are on the form itself.

If you need help, you can email via cwicb.cwphm@nhs.net

Some things to note

If you are aged 16 or above, we will process your ‘right to object’ form by carrying out our normal checks on the details you have given us.

From the age of 13 to 16, we will consider your right to object if your form has been signed on your behalf by someone with parental responsibility.

If it has not, we will ask a recognised health or care professional if they consider you to be competent to make such a decision.

If you are under the age of 13, we will only consider your right to object if your form has been signed on your behalf by someone with parental responsibility.

We’ll always respect your choice and restrict access to your health and social care information by professionals in our partner organisations where you’ve made use of your right to object. However, to carry out your wishes, we may need to keep some information such as your name, date of birth and NHS number.

This will ensure all partner organisations know about your decision to object so you don’t have to notify all the different organisations across Coventry and Warwickshire who might be involved in your care.

Objecting for someone else

If you are objecting on behalf of someone else, do not use the online form. Please complete the postal form instead.

If you’re under 16

If you’re under 16 and want to object, do not use the online form. Please complete the postal form instead.

If you change your mind

If you object by using either this online form or the postal/email version mentioned above, you can change your mind at any time. You can reverse your decision by completing this form. You’ll find details of how to send it to us on the form itself.

How we use your information

The information you submit through our forms is held securely. We will use it only to process your request. For more details on how we use your information, please see our privacy notice.

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