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Consent
Consent
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Your request
Are you contacting us about:
Are you contacting us about: mandatory field
Yourself
Someone else
A client
Your organisation:
Your job title:
Social prescribing
Surgery:
mandatory field
Beechcroft
Chet Valley Medical Practice
Church Hill Surgery
Harleston Medical Practice
Heathgate Medical Practice - Poringland
Heathgate Medical Practice - Rockland
Hingham Surgery
Humbleyard Practice - Cringleford
Humbleyard Practice - Hethersett
Humbleyard Practice - Mulbarton
Lawns Medical Practice
Long Stratton Medical Partnership - Long Stratton
Long Stratton Medical Partnership - Newton Flotman
Old Mill & Millgates Medical Practice - Hempnall
Old Mill & Millgates Medical Practice - Poringland
Parish Fields Practice
Roundwell Medical Centre
Windmill Surgery
Wymondham Medical Partnership
Data collected on this form may be shared with the University of East Anglia for the purpose of research into social prescribing. You will be identified in this process only by your NHS number.
Information sharing consent
Early Help Hub Aims:
Agencies and organisations in Norfolk are working together differently to better meet the needs of families and provide the help that they require as early as possible. In order to help families get the support they need, we must improve how we share information about the families we are supporting.
About Us:
Norfolk County Council and/or the relevant Local Authority will collect this information on a Sharing and Consent Form, and are initially what is called the Data Controllers of the Early Help information. With your consent we collect this information, store it in written/electronic form and share it with appropriate partners. Early Help Partners may include but are not limited to;
Norfolk County Council, Children's Centres, Department for Work and Pensions, Health services, Local City & District Councils, Norfolk Constabulary, Probation, Registered Social Landlords, Schools, Early Years settings, Voluntary Agencies, Youth offending team.
Your Rights:
Each organisation with whom your information is shared will comply with data protection legislation. To find out more about your rights, you can review NCC's and/or your relevant Local Authority's Data Protection Policy available on their website. This form will be retained for 6 years by the Data Controllers and in compliance with the Partner's retention policy.
Your Consent:
Information about you and your family will normally only be shared with your consent. The only times we might lawfully share information without your consent is if it is necessary:
To find out if a child or adult is at risk of harm or we need to help a child or adult who is at risk of harm; or
For the prevention or detection of crime.
So that we can work with you as well as other members of your family, it is important that everyone gives their permission for their information to be shared. Your children can give their own permission if they are old enough to understand what this means. If you, or a member of your family, change your mind you have the right to withdraw your consent, and can do so by contacting Norfolk County Council e)
information.management@norfolk.gov.uk
or any relevant Early Help Partner organisation, including your relevant Local Authority.
Please confirm that you agree to the following:
I understand the information gathered regarding me/my family will be used for the purpose of providing Early Help services to my family, and this will include the information being sent to Norfolk County Council and held and shared with the early help services below for the purposes of;
The provision of Early Help services to me and my family
Establishing whether I am eligible for the Family Focus service
Evaluating and assessing how these services have benefited me and my family
Early help services may include but are not limited to;
Norfolk County Council, Children's Centres, Department for Work and Pensions, Health services, Local City & District Councils, Norfolk Constabulary, Probation, Registered Social Landlords, Schools, Early Years settings, Voluntary Agencies, Youth offending team.
For Safeguarding Concerns please call the Multi Agency Safeguarding Hub on 0344 800 8020.
Your consent
Please list any individual or organisation that you do
not
want your information to be shared with.
I confirm that I have had consent (verbal or otherwise) for information to be shared, excluding with those individuals or organisations listed in the next box.
Is there any individual or organisation that you do
not
want your information to be shared with?
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