Medical Query Form Despite the best efforts of the health care team to record notes that are honest and distinguish fact from opinion there may be occasions where information is recorded that is misinterpreted. Information that is factually incorrect may be considered for redaction, however in general all information should remain as part of a comprehensive contemporaneous medical record. Retrospective notes may be added to clarify anything that is misrepresented. The decision to withhold information from online view rests with the clinical team. Where possible this will be undertaken. If you wish to raise a query over a medical entry in your notes, please answer the following questions and submit them to the practice. We aim to respond to your request within 4 weeks, however we appreciate your patience as we prioritise the provision of good clinical care.Full Name Date of Birth DD slash MM slash YYYY Contact NumberRelationship to the patient: I am the Patient Parent/Guardian Other What Other? Optional What information on the medical record would you like to query?:What date of entry does this refer to?: Optional DD slash MM slash YYYY What outcome would you like as a result of this query?:Do you consent to be contacted by SMS, if possible?: Yes No If yes, please ensure you leave a mobile contact number. OptionalThis form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data. By completing this form I consent to the practice collecting and storing my data from this form.
