Medical Entry Query - Montpelier Health Centre

The Medical Entry Query form is only to be used for querying or contesting information on a patient’s medical record. For general medical queries and requests for clinicians relating to your health, please submit an online consultation.

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

Contact Number

Relationship 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?:

What outcome would you like as a result of this query?:

Do you consent to be contacted by SMS, if possible?:

Yes

If yes, please ensure you leave a mobile contact number. Optional

This 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.