Consent to share information and your information sharing preferences

As part of your medical assessment and care plan, we may need to gather from and share information with other services and agencies involved with your care, for instance your referring GP. We recognise that we have a legal duty of confidentiality to protect your information and will always seek your consent to share it where appropriate.

In certain circumstances we may have to share information about you without your consent, where there is a risk to yourself or others or when instructed to by a court of law. In these circumstances, the information shared will always be kept to the minimum necessary and will be handled under the terms of the NHS Confidentiality Code of Practice.

This form gives you an opportunity to clearly state your wishes concerning the sharing of your information with those involved in your care.

You can change your mind about sharing this information at any time. Please contact the healthcare professional in charge of your care to record any changes to your information sharing preferences.

Information sharing with the perinatal mental health team (Cambridgeshire and Peterborough NHS Foundation Trust) by your maternity hospital or health visiting provider.

We would like to ask for your explicit consent for read only access to your mental health records whilst you are receiving care from our team.

Sharing notes between ourselves and your other care providers helps us to stay informed on your situation, reduce the number of times you need to repeat yourself and alerts us more quickly to deterioration or changes in your condition/ welfare. All of these things lead to enhanced care.

I __________________________ give consent to the obstetric team at Cambridge University Hospitals NHS Foundation Trust having read-only access to mental health records held by Cambridge and Peterborough Foundation Trust (CPFT):

Yes ☐ / No ☐

I confirm that I have read and understood the above information and I understand that I can change my mind at any point and should contact the healthcare professional in charge of my care to record any such changes to my information sharing preferences.

Signed: _________________________________
Date: ___________________________________

In order to continually improve our service we provide, from time to time we undertake research and service user evaluation.

We would like to ask your permission to contact you in the future (this may be after your baby is born) to invite you to participate in any projects we are undertaking or to provide feedback of your patient experiences.

Would you be happy for us to contact you in the future for:

• Research? Yes ☐ / No ☐
• Service evaluation? Yes ☐ / No ☐

If so, please let us know how you would prefer to be contacted:

• Post: Yes ☐ / No ☐
• Phone: Yes ☐ / No ☐

Thank you for taking the time to complete this form.