REG - YSJ Registrations

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Important please read.

Shared Care Prescribing and Monitoring – Our Approach

We want to make sure all patients get safe and consistent care. Because of this, our policy is to only share care (when your GP prescribes specialist medication and undertakes monitoring recommended by a specialist, and you also remain under specialist support) with NHS providers and if there is an NHS funded local shared care arrangement in place.
- NHS funded local shared care arrangements are available for some conditions (such as ADHD, inflammatory arthritis and a number of other conditions and medications).
- NHS funded local shared care arrangements are not currently available at present for some other specialist treatments unfortunately (such as gender-affirming care). We continue to advocate for more specialist service provision.
This means:

If you ask us to take over prescribing from a private provider, under a shared care agreement.
– We cannot do this until you have been seen by an NHS service- we can refer you to an NHS service if you wish.
– We can only do this where there are NHS funded shared care arrangements in place.
– This is to make sure there is full assessment, support, and timely review by the specialist.

If you are moving into the area and have been under private care with private prescriptions
– You will need to continue to get your prescriptions and monitoring with your private provider (unless you ask us to refer you into the NHS).

If you are moving into the area and already have private specialist/GP shared care
– You will need to arrange to get your medication and monitoring through your private provider, or, if you are a student, stay with your home GP if possible.
– We can refer you into an NHS service (for example The Retreat for ADHD) and once you are seen, we can then arrange shared care prescribing and monitoring.

If you are moving into the area and have NHS specialist/GP shared care
– If there is a funded local arrangement where the specialist will share care at the point of making the referral (for example ADHD care at the Retreat in York) we will continue the shared care arrangement once you are referred locally.

We understand this can feel frustrating, but this policy is in place to keep care safe, consistent, and fair for all patients. We will always explain your options clearly and help with NHS referrals where appropriate.
How did you hear about us?*
Select if you are from the UK or abroad*

UKAbroad
Which University do you attend?*

York St John UniversityUniversity of York
Academic Course*
OT, Diagnostic Radiography, Physiotherapy, Paramedic & Nursing, Speech and Language Therapy, Operating Department Practice, Students will require additional occupational vaccinations in order to take part in placements.
Vaccine Coding
First Name*
Surname*
Date of Birth*

DayMonthYear
NHS Number*
✎ Don't know your NHS Number? Click here to find it.
Registered Sex*
Gender*
Town & Country of Birth*
Your York Address

Please give the details of the address you will be living at during your time at University
Please could you enter all of your accommodation address details to include your room and/or flat number/letters/block number.

This is important so that you can receive relevant mail from us and the NHS relevant screening programmes.
Building Name/Number*
Block
Flat Number
Street Address*
City*
Postcode*
Your Address OLD*

Street Address

Street Address Line 2

CityState / Province

Post Code
Postcode*
YES - POSTCODE IN AREA
NO - POSTCODE IS OOA
POSTCODE SCORING
Preferred Telephone Number*
This can be a mobile or landline telephone.
Additional Number
Optional: Please provide a secondary contact number
Email Address
Next of Kin (means the closest living relative who should be contacted in case of an emergency.)*
Next of Kin: Relationship*
Contact details*
It is important to let us know if you are a Carer for someone. There are support services we could share with you and update you on the incentives available. If you are unsure of what defines a Carer please see the below definitions:
- An Adult Carer is someone who is caring for someone over 18 years of age and who might be struggling to manage caring alongside employment, or 'sandwich carers' these are people who coud be caring for a disabled child as well elderly parents. This group of carers also includes older adults, often co-caring for one another
- Young Adult Carers are young people aged 16 to 25 years of age. They may or may not be in education/ employment/ training and may be struggling to manage the transition of support for them/ family member as they turn 18 years of age.
- Young Carers are under 18 years of age and they might not fully understand their caring role and might be caring for a parent who has parental responsibility for them.
- Parent Carers provide support to their children, who have additional needs including illness, disability, or have mental health or substance misuse problems.
More Support can be found at https://yorkcarerscentre.co.uk/
Are you a Carer?

YesNo
Do you have a Carer?

YesNo
Reasonable Adjustments at Our General Practioner (GP) Practice
We want to make sure everyone can access our services comfortably and equally. If you have a disability or impairment, we can make Reasonable Adjustments to support you.

Do you have an impairment that has a substantial and long-term effect on your daily activities?
If so, please let us know—our team is happy to discuss what support might help.

Examples of adjustments we can offer include:
- Longer appointments if you need more time
- Accessible communication, such as large print, Braille, or an interpreter
- Physical changes, like step-free access or accessible toilets
Do you feel you have a Reasonable Adjustment

YesNo
Armed Forces
If you have amswered Yes we will send you a follow up questionnaire for more information.
Address before enlisting

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service or Personnel number
Enlistment Date

DayMonthYear
Discharge Date

MonthDayYear
(if applicable)
Housing*
Previous UK Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date you first lived at this address *

MonthDayYear
(approximate)
Name of Doctor or Surgery when at that address*
Address of Doctor or Surgery*

Street Address

Street Address Line 2

CityState / Province

Post Code
Date arrived in the UK*

DayMonthYear
Expected date of leaving the UK*

DayMonthYear
Date
Your first UK address where registered with a GP (only if you have previously registered with a GP)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If a previous resident in UK, date you left

DayMonthYear
Signature*

Clear
By signing you agree that the information submitted is correct
All about you

Please answer to the best of your knowledge
Medical History

AsthmaCOPD (Chronic Obstructive Pulmonary Disease)EpilepsyHeart DiseaseHeart FailureHigh Blood PressureDiabetesKidney DiseaseStrokeDepressionUnderactive ThyroidCancer
Vaccine Coding 2
Family History

AsthmaCOPD (Chronic Obstructive Pulmonary Disease)EpilepsyHeart DiseaseHeart FailureHigh Blood PressureDiabetesKidney DiseaseStrokeDepressionUnderactive ThyroidCancer
Do you smoke?

YesNoUsed to smoke
How many units do you drink in an average week?
Height
In centimetre (CM)
Weight
in kilogram (KG)
Do you require an Interpreter?

YesNo
Do you have any additional communication needs?

YesNo
Please select your additional communication need
First Language*
Ethnicity*
Religion
Which of the following options best describes how you think of yourself?
Consent to Share Information

Summary Care Record (SCR) - this is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had. Having this information stored in one place makes it easier for healthcare staff to treat you in an emergency, or when your GP practice is closed. Do you give your permission for us to share the following data?
Your medications, allergies and adverse reactions?*

YesNo
Your medications, allergies and adverse reactions & additional information?*

YesNo
Important Information

It is practice policy to share information that is recorded on your clinical record with other clinical staff that you are under the care of to ensure the best care is provided to you. For further information visit www.nhscarerecords.nhs.uk/carerecords.
Do you consent for us to share your medical records with other medical service you may be using i.e. District Nurse Teams, Podiatry or Dieticians?*

I agree to opt inI do not agree
Do you give explicit consent for us to contact you via text SMS message with test results and appointment reminders?*

YesNo
Important Consent Sharing for Health Sceince Students Only

If you are studying OT, Diagnostic Radiography, Physiotherapy, Paramedic & Nursing, Speech and Language Therapy, Operating Department Practice. Students are required to share additional health information with Heales Medical to take part on their course placements.
Do you consent to share your vaccinations and investigations with Heales Medical for course placement purposes

YesNo
Would you like to be involved in our Patient Participation Group? The PPG enables us to gain valuable feedback about your experiences, views and ideas for improving our services (Suitable for 16 years and over)

YesNo
Optional: Do you use Electronic Prescribing? If yes, please inform us of your nominated pharmacy
Optional: If you needed an organ or blood transplant would you have one?

If so, please help those in need of a transplant by opting to donate organs, tissue and/or blood.

Click here to opt in to donate blood

Click here to opt in to donate organs/tissue

Click here to opt out of donating organs/tissue
HIDDEN SECTION: ANSWER

This section will be hidden to patients. It is used for coding calculations only.
Gender Code
GMS1 CODE
INFORMED OF NAMED GP
PATIENT ALLOCATED NAMED GP
Are you a carer?
Do you have a carer?
Do you require an Interpreter?
Armed Forces
Housing
Do you smoke?
How many units do you drink in an average week?
Height
Weight
First Language
Additional Communication Needs
Ethnicity
Religion
Orientation
Your medications, allergies & adverse reactions
Your medications, allergies & adverse reactions & additional information?
Do you consent for us to share your medical records with other medical service you may be using i.e. District Nurse Teams, Podiatry or Dieticians?
Do you give explicit consent for us to CONTACT YOU via text message?
Would you like to be involved in our Patient Participation Group?
Reasonable Adjustment
Vaccination Course
Heales Consent
Should be Empty:

Your York Address

All about you

Consent to Share Information

HIDDEN SECTION: ANSWER