Care Homes

Trinity Medical Centre primarily serves 2 large care homes in the area. Carr Gate and The Sycamores.

Patients from other care homes in our catchment area are welcome to register however they will have their own assigned Primary Care Provider who will be able to offer a more knowledgable and efficient service.

We do weekly virtual ward rounds with our care homes, making sure we can review patients regularly in an attempt to prevent problems before they become more acute.

If you are a care home and wish to register a new patient with the practice, please use the form below to register your patients.

New Patient Registration Form for Care Homes

Patient Details

Use this form to register for General Medical Services at Trinity Medical Centre and Sandal Castle Medical Centre. A form must be completed for each patient wishing to register for family doctor services. For our full privacy notices and information on the data we collect, please see our website;
Mr, Mrs, Miss ect..
Gender
Date of Birth
IMPORTANT: THIS IS NOT YOUR NATIONAL INSURANCE NUMBER. Please contact your previous surgery to obtain. https://www.nhs.uk/using-the-nhs/about-the-nhs/what-is-an-nhs-number/
Town/City and Country
**If you were born outside of the UK please enter the date you arrived in the UK.
Address
Do you speak English?
Where would you like us to send your medication to when issuing prescriptions?
Next of Kin / Emergency Contact – First Contact
Name
Relationship
Mobile Number
 
Next of Kin / Emergency Contact – Second Contact
Name
Relationship
Mobile Number
 

Previous GP

Please help us trace your previous medical records by providing the following information
Your previous address in the UK

Accessibility

Do you consider yourself to have a disability?

If you answer YES please complete the rest of this section.
Details of impairment
Written Communication support

Verbal/Face to Face communication support

Carers

This information helps us support our patients and their carers in the best way possible. If you need further advice on Carers in the Wakefield area please visit: https://www.carerswakefield.org.uk/

Health Information

Are you a carer?
Is someone a carer for you?
If you answered yes to having a carer, you can give us their name and contact number if you wish for us to have this on your record.

Health Information

Please provide this in cm/m
Please provide this in kg
On End of Life Care?
How often do you drink alcohol?
How many standard alcoholic drinks do you have on a typical day when you are drinking?
How often do you have 6 or more drinks on one occasion?
Smoking Status
For information and support to stop smoking, please visit Yorkshire Smoke Free https://wakefield.yorkshiresmokefree.nhs.uk/
Do you have a drug addiction?
If you answer yes. please give information below
Please give information about addiction issues and if you are engaged in a substance misuse service.

Medical History

Are you currently under any hospital care?
Do you have any known allergies?
Please list your medication here
Please list any health problems or long term conditions such as Asthma, Diabetes and any other relevant medical information
Have any of your immediate relatives (brothers/sisters/parents) had any of the following;

Women's Health

Optional
Are you currently pregnant?

Data Sharing

Please complete this questionnaire to ensure we can record your preferences for the use of the data we store and share about you. For more information please see our practice website.
Consent to SMS messaging
The practice stores your mobile number to ensure we can contact you when we need to. We would also like to use this to send you important reminders such as appointments or other important notices. We will never share your mobile number and we will only use it for appropriate reminders.
Consent to Email Messaging
The practice stores your email address to ensure we can contact you this way when we need to. We would also like to use this to send you important reminders such as appointments or other important notices. We will never share your details and we will only use it for appropriate reminders.
Summary Care Record (SCR)
NHS in England use the Summary Care Record in emergency care to ensure those caring for you have enough information to treat you safely. For more information on your health records please see: https://www.nhs.uk/using-the-nhs/about-the-nhs/how-to-access-your-health-records/
Do you consent to the sharing of data recorded at Trinity Medical Centre with any other organisations that are involved in your direct care?
Our practice uses a computer system called SystmOne that allows the sharing of full electronic records across different care services that you use. You can choose to permit or restrict access to the information entered into your record at each organisation that accesses your record. You will be asked to give record sharing consent at each organisation at which you receive care. Your consent can be changed at any time.
Do you consent to Trinity Medical Centre being able to view information that is recorded at other care services that may care for you (and where the patient has agreed to make the data shareable)?