FAQs » New Patients

How do I register as a new patient in Elmwood?

We welcome any new patients who live within our practice area. If you wish to register with the practice then please come and visit the surgery in person, where our reception staff will take your details. Please fill out the following form and bring it with you.

Patient Registration Form

In order to provide for your care we need to collect and keep information about you and your health in your personal medical record. Please complete the following form. The information will be used to create your personal medical record on the practice computer.
Our practices are consistent with the Medical Council guidelines and the privacy principles of the Data Protection Acts. For further details please see our Practice Privacy Statement

Part 1

Surname:__________________ First name:________________

Known as:_____________________________________________

Title: Mr. /Mrs./Ms./ Other_______________________________

Date of birth:_____________________ Gender: Male / Female

Address:_____________________________________________

_____________________________________________________

Phone: Home:__________________ Work__________________

Mobile__________________

I am happy to receive alerts from the practice by:
Mobile phone ?

GMS number:__________________ Expiry date:____________

Next of kin:
Name:_______________________________________________

Address:______________________________________________

Relationship:__________________________________________

Phone:_______________________________________________

Previous GP name and address:__________________________
_____________________________________________________

Pharmacy name and address____________________________
_____________________________________________________

PPS Number ______________________

To avail of certain governmental schemes (e.g.
Social welfare certificates, Mother and Child Maternity Scheme,
Cervical Check, Childhood vaccinations) it will be necessary for
you to provide us with your PPSN number.

Private Health Insurance Provider:_________________________

Further information: The following information is not essential
but may be of use to your doctor when they are diagnosing a
problem or deciding on a treatment plan for you.

Marital Status:_________________________________________

Occupation:_ __________________________________________

Ethnic origin:__________________________________________

How did you hear about Elmwood Medical Practice?

____________________________________________________

Part 2 – Health History

Past Medical History:

_____________________________________________________

Last Smear Test & results
_____________________________________________________

Family Past Medical History:

_____________________________________________________

Allergies:

Current medications:
If you are unsure you could bring your empty pill boxes with
you or get a printout from your pharmacist.
_____________________________________________________

Do you smoke?_______________________________________

Do you drink?________________________________________

When was the last time you visited a G.P.?
_____________________________________________________

Part 3 – Family Members

Do you have other family members already registered at Elmwood? If so, can you please provide us with the following:

Surname: ____________________ First name: ___________________
Date of birth: ________________
Surname: ____________________ First name: ___________________
Date of birth: ________________
Surname: ____________________ First name: ___________________
Date of birth: ________________
Surname: ____________________ First name: ___________________
Date of birth: ________________

Part 4 – Patient Statement

I_________________________________________ (Print Name)

have received a copy of the Data Protection Patient Information Leaflet

I_________________________________________ (Print Name)

have signed a separate consent to data processing;
__________________________________ __________________
Signature Date Date

Can I register with a specific Doctor?

If you have a preference with regards to registering with a particular doctor, please make this known to the receptionist when registering.

Archive Patient's File

Elmwood Practice protocols states we will close your patient file if you have not attended the practice within five years. Your Chart will remain on file but if you wish to see a GP again you will need to re-register with the practice as a new patient. When you re-register you are not guaranteed to be accepted, this will depend on current guidelines within the practice if we are accepting patients at that time.

Data Retention Records

In general, medical records should be retained by practices for as long as is deemed necessary to provide treatment for the individual concerned or for the meeting of medicolegal and other professional requirements. At the very least, it is recommended that individual patient medical records be retained for a minimum of eight years from the date of last contact or for any period prescribed by law. (In the case of children’s records, the period of eight years begins from the time they reach the age of eighteen).

We follow the guidelines set by the HSE which suggest minimum retention periods as follows:

PATIENT TYPE MINIMUM DURATION
General (Adult)

8 years after last contact

Deceased patients

8 years after death

Children and young persons

Retain until the patient’s 25th birthday or 26th if young person was 17 at the conclusion of treatment, or 8 years after death. If the illness or death could have potential relevance to adult conditions or have genetic implications, the advice of clinicians should be sought as to whether to retain the records for a longer

Mentally disordered persons (within the meaning of the Mental Health Acts 1945 to 2001)

20 years after the date of last contact between the patient/client/service user and any healthcare professional employed by the mental health provider, or 8 years after the death of the patient/ client/service user if sooner

Death – Cause of, Certificate counterfoils

2 years

Maternity (all obstetric and midwifery records, including those of episodes of maternity care that end in stillbirth or where the child later dies)

25 years after the birth of the last child

Records/documents related to any litigation

As advised by the organisation’s legal advisor. All records to be reviewed. Normal review 10 years after the file is closed

Suicide – notes of patients having committed suicide

10 years

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