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Please note, throughout the changing situation caused by the COVID-19 outbreak, we continue to work with NHS England to prioritise services so that we can make sure they run smoothly, avoiding disruption to front line Primary Care.

These essential services for patient registrations are; processing of patient registrations, immediate (SAS and 8 day) removals and dealing with any messaging errors on the GP links between practices and PCSE to ensure that patient care can continue during this time.

As we focus on these activities, other registration processes such as duplicates, adoptions, confusions and gender re-assignments may take longer to process.

 

Registrations

A Guide to Patient Registrations

PCSE processes new patient registrations and de-registrations at GP practices. We ensure that NHAIS (the national patient records database) reflects what is shown in each practice’s patient list.

To keep you up to date with patient registration processes, we have produced a simple and easy to use Guide to Patient Registrations which is available to download here.

We hope you find the information useful. You can either download the complete guide via the link above, or use the quick links below to find the section of the guide you need.

 

 



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Data Quality Checks

List Reconciliation and Data Quality Checks on Patient Lists

To release as much capacity as possible back into General Practice patient facing activities, NHS England has instructed us to pause all routine list reconciliation and data quality checks. 

This does not include activities required to ensure new patient registrations are processed in a timely manner (for example responding to rejected registration queries or processing changes of identity such as adoptions), which are essential to ensure patients are registered and therefore able to access primary medical services

Patient list data quality checks are carried out to reduce the number of patients incorrectly registered with GP practices. The checks ensure that details held on PDS/Spine are accurate. There are many reasons to ensure practice lists are current and accurate; it helps to ensure that patients are included in relevant screening programmes and ensures that practices are paid correctly for the number of registered patients they have.

The data quality checks are managed by the Primary Care Support England (PCSE) Registrations team on behalf of NHS England.

The process checks the following six groups:

  • Patients aged over 100
  • Patients that migrated to England 12 months ago (Transient)
  • Patients registered at an educational facility for four or more years (Students)
  • Patients aged under 16 showing as the sole occupier of a property (Orphans)
  • Properties the Royal Mail report as demolished (Demolished Properties)
  • Properties with eight or more registered inhabitants (Multiple Occupancy)

 

PCSE compile a separate patient list for each group and send these to either the GP or a letter to the patient directly requesting that the registration details are confirmed. Upon the return of information, PCSE will either:

  • add a note to the patient record to say that the details are correct for example reg confirmed, whereabout known, seen recently
  • process the patient deduction sent via GP links (if confirmed they have moved away or become deceased), or
  • apply an FP69 marker (which will result in the patient deducted in 6 months’ time unless an update to the patient details or a new registration is received in that time).

PCSE is required to carry out routine data quality checks on the patient details it maintains.  The request contains details of patients our records show are registered with your practice. Your practice is required to confirm whether or not the details held are accurate. The guidance supplied will help you to complete the information requested. It is important that your practice responds in order to ensure that eligible patients can be contacted for routine screening, and that payments based on patient registration data are accurate.

A ten day period is provided to all GP practices to review the patient data and complete all associated actions, including any required patient deductions. The reason why there is a 10 day limit is that data becomes out of date and so any changes need to be applied quickly.

Once all actions are complete for this patient list data quality check, the PCSE team will make further contact with your practice again to request confirmation of patient registration data for other cohorts of patients. This is in line with the NHS England policy.

An FP69 is a flag that is set on a patient’s registration record when it is believed they no longer live at the registered address.  When the flag is set, a message is sent electronically to the GP practice clinical system, advising them that the details may be incorrect, and asking them to provide a new address, or to confirm if the patient is still living at the address held.  GP practices should be contacting patients to establish whether or not they have moved or should be removed from the register.  If no response is received from the patient or the GP practice, the patient will be removed from the practice list of patients six months later.

PCSE is notified of demolished properties on a quarterly basis by Royal mail and a FP69 flag has been set because it is believed that the patient no longer lives at the registered address. 

NHS England guidance on the policy for managing patient lists can be accessed in part B, chapter three of the NHS England Primary Medical Care Policy and Guidance manual (PGM) available here.

If PCSE does not receive a completed spreadsheet, an FP69 flag will be applied to any patients concerned. Notification of these flags will be received through GP links onto your clinical system. The setting of the FP69 flag will give the practice six months to confirm the registration status. To confirm the registration status the practice should add a note to the patient record such as ‘address confirmed’ or ‘seen recently' through GP links. Alternatively, the practice can provide an updated address before the patient is removed from the practice list. If no action is taken this could result in patients being excluded from routine screening programmes.

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Patient Registrations

 

New registrants include babies, patients recently arrived from overseas and any other patients who have an NHS number allocated for the first time at the point of registration.

All new registrants to the NHS will be issued a new medical record envelope (also known as the Lloyd George envelope) that will be sent to the GP with whom they registered. This will arrive on your usual weekly courier delivery that delivers and picks up your records requested for movement / transfer.

PCSE will then send a new registration letter directly to the patient’s home address.

Replacement registration letters or medical cards are not provided. If a patient needs their NHS number, they can get this from their current GP.

The patient will only receive a confirmation letter for a registration of a birth, or if they have never previously been registered with a GP practice and have a first time registration.  Immigrants, and people registering for the first time after moving into the country will also receive a letter.

Registrations are usually processed by PCSE within 3 working days but it can take up to 10 working days. If you have not received an acknowledgement to a new registration within 10 working days this indicates there may be an issue with the GP link and you should contact us to check the status of the registration.

You can download a guide for practice staff on the supplementary questions section of the GMS1 form, information on how to process them, and other frequently asked questions here.

Practices should only use High Security when requested to do so by PCSE. 

Any actions carried out under High Security update the clinical system ONLY and results in no GP links transaction being sent to PCSE. 

High Security should only be used as a corrective measure for failed GP link transactions. 

Typical examples of when High Security should be used are as follows:

  1. Patient is active on the clinical system but not registered with PCSE

This indicates that a patient’s registration has been approved under high security. Practices should manually deduct the patient under high security using their security password, come out of high security and then send a new registration through the GP links system as if they are registering them the patient for the first time.

  1. Patient has been deducted by PCSE but remains registered on the clinical system

This indicates that no deduction has been received through GP links and therefore the practice is required to manually deduct the patient under high security.

  1. Patient’s registration is unacknowledged on the clinical system but is registered with PCSE.

The practice needs to manually approve the registration under high security. This will remove the patient from the ‘unacknowledged list’ on the practice’s clinical system.

If assistance is needed in manually deducting/approving registrations, please contact your clinical system supplier.

Please note:

  • All deductions should be sent via the GP links system
  • Patients should not be manually deducted from your clinical system unless this is requested by PCSE
  • Manual deductions made under High Security will only remove the patient from your clinical system and will not remove them from the national spine system or PCSE system records. All three systems should match
  • In the event that a manual deduction is made under High Security, please inform PCSE via email, stating the reason for the deduction and a forwarding address for the patient.

Download the guide to using the High Security setting on your practice clinical system

Please register the patient as normal. In the field for the patient’s address, please enter the full address for the GP practice including the practice postcode, putting CO (Care of) at the start of the address.

Please note, putting ‘no fixed abode’ in any field would cause the registration request to be rejected.

Guidance on Residential Institute (RI) Codes

• Adding a Residential Institute Code to a patient record is the responsibility of GP practices
There are currently a number of different processes used in different areas to link patients to residential institutes.  To make things simpler to follow, two new RI codes have been created that can be used nationally 
V0 – is to be used for patients who reside in a care/residential home
Y0 – is to be used for students who are residing at a school or university.
• Please note that the 0 in the code is a zero
• You will need to set both these codes up on your clinical system in order to add them to patient records. Practices are not required to recode all previous RI codes.
• Please ensure you use the correct code for the type of patient

Please inform us if a new care home opens in your practice area.

• PCSE maintains lists of care/residential homes. In order for the V0 RI code to be added to a patient’s record on NHAIS/Exeter, the care home must be listed with PCSE and on the NHAIS/Exeter patient registration system
• If a new care/residential home opens within your practice area, you will need to contact PCSE so that the care/residential home can be added to the list by emailing pcse.registrations-preston@nhs.net (see details below)
• Please ensure that the home is listed with the Care Quality Commission before requesting it is added to the list of homes
• This should not stop you from registering patients immediately as the RI code can be added to the record once PCSE has confirmed the home has been added. You will need to register the patient as usual, then once PCSE has confirmed the care home has been added, you will need to add the code to the patient record and send to PCSE as an amendment via GP links.

If a new care home opens in your area, please email pcse.registrations-preston@nhs.net to let us know, and include the following information:
• The name of new care home
• The full postal address of the new care home

Download guidance on Residential Institute (RI) Codes

  • For patients registering in England for the first time having previously been registered in Scotland, Northern Ireland or Wales, please select the registration type on your clinical system that you would if the patient was registering from another area of England and include their previous address. This will ensure that PCSE have the necessary information to request the medical record from the patient’s previous practice
  • PCSE will then process the registration and send confirmation to the practice via the clinical system
  • The National Back Office will initiate the deduction of the patient at the previous practice which triggers the request for them to release the medical record for transfer on to the new practice
  • The previous GP practice releases the record to the relevant Health Board who send the patient record to PCSE via courier
  • PCSE locates the new practice details, and sends the patient record to the new practice via CitySprint, with their usual records delivery.

Please note:

  • GP2GP will not work for patients transferring from GP practices in NI and Scotland
  • PCSE is reliant on the timely release of the patient record from the old practice in order to send it on to the new practice

When searching for a new patient using your clinical system it is important to use the exact details provided by the patient as there may be two or more patients with very similar details.

If you are unable to trace the patient’s NHS number, please note that PCSE are unable to provide you with the patient’s NHS number until a registration has been received via the GP links and has been processed.

Please note that it takes up to 24 hours for a transaction to reach PCSE once it has been submitted by the practice.

You do not need to include an NHS number on a patient’s registration for it to be processed as long as you have included the following essential information.

Ensure that you include:

  • The patient’s full details including place of birth (unknown not acceptable)
  • Previous addresses
  • Previously registered GP surgeries

This will help us find a match on the national spine. 

Once the transaction has been processed by PCSE you will receive the NHS number for the patient via the GP links.

The rest needs to go in ‘tips for a smooth registrations’ this is in the faq ‘useful guides for registrations.

 

Immigrants not to put in a previous address

If the patient is an immigrant and this is their first registration in the UK, then please include their place of birth.

Please do not provide a previous address on the registration of an immigrant unless the patient has confirmed they have previously been registered with the NHS. If they have been registered previously then their previous address must be provided.

Please note: As part of a visa or immigration application, patients may pay the immigration health surcharge. This results in them being allocated an NHS number before they arrive in the UK.  These will show on the National Spine but not linked to practices and their address will show as ‘address not known’. 

 

Patients that were born in the UK but have been out of the country for a number of years

If the patient was born in the UK and has lived abroad since pre 1996 please register the patient as an immigrant ensuring the dates that the patient left the UK and entered the UK are provided.

 

Private Patients

If you are registering a private patient for the first time i.e. they have not been registered with the NHS prior to the mid 90’s, please put a note in the GP message field write ‘private patient not previously registered with the NHS.’

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Deductions

 

If you need to cancel a patient deduction request which you have sent to us via your clinical system, please note that removing the flag on your local clinical system will not update the request into PCSE.

To inform PCSE that you need to cancel a patient deduction request, please either email the registrations team at: pcse.registrations-preston@nhs.net  putting ‘Cancellation of deduction request’ in the email subject line, or call PCSE on 0333 014 2884.

Please do not deduct the patient under high security/security controlled procedures as this will only update your clinical system. It will not remove the patient on Open Exeter or the National Spine. All deductions should be sent via the GP links.

Please do not action the change of the address on your clinical system. Please request a deduction with a reason of ‘Other Reason’/’Left Area’ and in the free text include the new address including house number/name, street and postcode. If you do not know the patient’s forwarding address please enter ‘Address Unknown’.

Once the deduction is received, PCSE will place the patient on a pending deduction for 30 days. A letter will then be sent to the patient at their out of area address, or last known address if the new one is unknown informing them they need to re-registered with a different GP practice. The deduction request will be rejected as the patient will only be deducted on the 30th day or upon a registration being received from a practice.

If you wish for a patient to be registered at the practice on your “Out of Area Scheme”, you will need to send a removal request for the patients through the GP Link as a deduction with 'OOA REG' in the 'GP Message' field. When this is received, the patient will be removed immediately and the practice must accept the deduction notification received. Once this has been done, the practice should then send a new registration request down the GP Links system, again with ‘OOA Reg’ in the GP message field.

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Amendments

 

To request to change date of birth information for a patient registered at your practice, please submit the amendment via the GP Link, and confirm in the free text that you have seen documentation with the correct date of birth. If this confirmation isn’t provided in the free text, then the amendment will be rejected

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Rejections

 

Depending on the reason for rejecting the registration, a numeric code is assigned to the registration, and we notify you in two ways.

Email

An email is automatically sent to the main contact at your practice, with specific information on the reason for rejection and what needs to happen next.

Clinical System

A message is sent to your clinical system, with the numeric code and the text "Email has been sent to the main contact at your practice"

 

You can find out more about the numeric code and reason for rejection, along with what needs to happen next in our Rejection Codes document

There is also more specific information in this section below on:

  • Notifying us of a change of main contact

Check that the practice code in the email subject line relates to the practice you work for. If this isn’t your practice you should check who the main contact is at your practice. If you need to update your main contact please contact our Customer support centre on 0333 014 2884.

If you do work at the practice, please do a full search on your clinical system for the patient using all the details provided in the email. If you still cannot trace the patient, please contact us using the online form  selecting ‘Registrations’ from the drop-down menu.

Emails about rejected registrations are sent to the registered PCSE main contact at your GP practice.

If you need to change your main contact details, please call the Customer Support Centre on 0333 014 2884.

Yes, you can change your registered PCSE main contact by calling our Customer Support Centre on 0333 014 2884

When a registration has been rejected it is no longer visible on NHAIS and cannot be amended or processed by PCSE, therefore you will need to make the necessary amendments on your clinical system as explained in the email from us and resubmit a registration through the GP link.

When you resubmit the registration with all the information required we will process and accept the registration.

The rejected patient registration will be in a file on your clinical system, please contact your system supplier if you are unsure where the file is located. Once located, you should be able to access the registration from here and make any amendments before resubmitting the registration.

If you cannot locate or edit the rejected registration will need to follow these next steps:

  • Approve the registration under high security, in order to do this you may need an NHS number. As the patient may not yet have been allocated an NHS number, especially if they are registering from outside of England or Wales you can use a dummy NHS number e.g. 999 999 9999.
  • Once approved, deduct the patient under high security so that they are showing as inactive
  • Proceed to re-registering the patient, adding in any additional information in the appropriate fields and removing the dummy NHS number

Once PCSE receive the registration we will either trace an NHS number or allocate and you will receive a notification on your clinical system.

If you have already resubmitted the registration, please disregard the email from PCSE and from your Commissioner.

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Patient Removals

 

As part of the services we provide, PCSE regularly writes directly to patients (for example through our new patient registration and practice merger and closure programmes).

In line with current procedures, if a letter is returned to PCSE as the patient has moved house, we are required to raise an FP69 flag on the NHAIS system. This will update the GP practice’s clinical system. The practice should then check the address directly with the patient, and confirm or update the address on their clinical system.

If PCSE doesn’t receive confirmation from the practice (via the link) that the patient is either still at the address or at a new address within 6 months of the FP69 flag being raised, the patient will then be removed from the GP’s patient list.  

Should the letter be returned to us as ‘moved abroad’ or ‘deceased’ the appropriate action would be taken to deduct the patient from NHAIS as O/R (other reason).

Immediate removals will be processed by PCSE within 24 hours of receipt of notification from the GP practice – this can either be by phone or by email. The incident must have been reported to the Police for the immediate removal to be processed. Secondary or local commissioner approval will not be necessary.

The updated policy includes a provision for the Special Allocation Scheme (SAS) provider to determine whether the removal request is appropriate. Practices have been advised of this update and the process to follow to request removal of a patient from a practice list.

PCSE is not responsible for determining if a patient meets the criteria for immediate removal, other than confirming the incident has been reported to the Police.  This is the responsibility of the reporting practice.

To request removal of a patient from your practice list (either immediate or within eight days), please complete the form which can be downloaded here. Once complete please email to: pcse.patientremovals@nhs.net.

If a Special Allocation Scheme patient attempts to register with a mainstream GP Practice, no warning or preventative message would be received by the practice's clinical system. However, once the registration is received via the GP link, the flag on the patient's record warns PCSE that the patient is subject to the Special Allocation Scheme.

PCSE will then reject the registration with a rejection note stating the patient is on the scheme, and to remove the registration from their clinical system.

The patient will then be contacted by PCSE via letter to say that as they are still subject to the Special Allocation Scheme, they are unable to register at a practice of their choice and that their registration with your practice has been cancelled.

Removal of patients from your practice list

Historically, there have been local variations in the immediate removals process. NHS England has directed that from 5 Feb 2018, all immediate removals will be processed by PCSE within 24 hours of receipt of notification from the GP practice – this can either be by phone or by email. The incident must have been reported to the Police for the immediate removal to be processed. Secondary or local commissioner approval will not be necessary.

The updated policy includes a provision for the Special Allocation Scheme (SAS) provider to determine whether the removal request is appropriate. Practices have been advised of this update and the process to follow to request removal of a patient from a practice list.

To request removal of a patient from your practice list (either immediate or within eight days), please complete the form which can be downloaded here. Once complete please email to: pcse.patientremovals@nhs.net.

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Patient Records, Duplicates and Confusions

 

Confusions

This is where two patients have the same NHS number – this often occurs when a patient registers with a practice, and the incorrect patient details are selected from PDS on the Spine, confusing the two patient’s details.

This can cause medical records to be combined for the two patients and can often result in the patient/s being registered between practices. Confusions carry a clinical risk, as they can result in a patient missing screening programmes and incorrect medical care being provided.

Download our Tips for Smooth Patient Registrations guide to avoid confusions. 

Duplicates

This is where you find one patient has two NHS numbers. Cases like this often lead to the medical records being mixed between two medical record envelopes, which could lead to the full patient history not being fully reviewed by practitioners.

Please notify PCSE of any confusions or duplicate cases. To do this, please go to www.pcse.england.nhs.uk/contact-us and select ‘Registrations’ from the drop-down menu on the enquiries form.

Once notified, PCSE will investigate the case and update NHAIS. PCSE will then log a request with the National Back Office to update the data held on PDS/Spine. The National Back Office can take between 4 – 6 weeks to return to PCSE. Overall it could take 6-8 weeks to resolve.

We will then complete and close the case within five working days.

 

 

Please contact us to assist you with this, by emailing the team at pcse.registrations-preston@nhs.net. 

There are many complexities when investigating these cases, and they need to be escalated to the National Back Office (NBO).

The NBO may need additional information, and if this is the case, the Registrations team will come back to the practice for this information. 

These issues have a longer timescale due to the complexity, and may take months, rather than a matter of weeks to resolve. 

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Adoption and Gender Re-assignment processes

 

Adoption process

It is important that practices are aware of the steps that need to be taken when a patient is adopted. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

When a patient is adopted, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record.

The process is as follows:

  • The National Back Office send the patient’s new NHS number and any other amended details (e.g. name, address) to PCSE
  • PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient  
  • GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care
  • PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice
  • GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the identity or whereabouts of the birth parents should not be included in the new record.

It is important that practices complete the new registration for the patient within five working days to ensure no interruption to patient care.

Download our guide for GP Practices for further information on dealing with medical records for adopted patients, 

Gender re-assignment process

It is important that practices are aware of the steps that need to be taken when a patient changes gender. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

Please note: Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so.

When a patient changes gender, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record. When the patient informs the practice that they wish to change gender, the practice must inform the patient that this will involve a new NHS number being issued for the them, which is not reversible. To revert back to their original gender, they would receive a third NHS number. The practice should confirm this has been discussed with the patient when notifying PCSE.

The process is as follows:

  • GP practice notifies PCSE that a patient wishes to change gender via the enquiries form. The practice should include the patient’s name and NHS number in the notification to PCSE, plus confirmation that they have discussed with the patient that this will involve the creation of a new NHS number
  • PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient  
  • GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care
  • PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice
  • GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the patient’s previous identity should not be included in the new record.
  • If the gender is being re-assigned from male to female, the screening team will contact the practice for no cervix confirmation
  • If the gender is being re-assigned from female to male, screening will become the responsibility of the practice.

It is important that practices complete the new registration for the patient within five working days to ensure no interruption to patient care.

Please note: When registering new patients please do not use Select ‘I’ (Indeterminate) as the sex category. Please only select either ‘M’ for Male or ‘F’ for Female. This ensures that the appropriate screening invitations go correctly to individuals.

Please download the Process to registering a patient gender re-assignment guide

  • It is up to your GP practice to define its own procedures about whether or not you ask patients to provide evidence for a name change.
  • There is no legal requirement for your practice to request evidence, although it is considered best practice to do so.
  • PCSE does not require confirmation that evidence has been seen in order to change the name, although we may contact your practice by phone or email to confirm the changes made.

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Patient Lists

 

It is the responsibility of each practice to maintain its patient list. If you think there is a discrepancy between the patient list on your clinical system and the patient list PCSE hold for your practice, please email your patient list to PCSE at pcse.dataquality@nhs.net after the next quarter end period with the following information:

  • Your name
  • The name of your GP practice
  • The address of your GP practice
  • Your practice telephone number
  • The ODS code for your practice (GP main practice codes are a letter followed by five numbers)

PCSE will review your practice list. If necessary, we will send your practice a set of actions based on the outcome of the review. These actions will ensure that all patients are accurately registered and must be implemented as a matter of urgency.

Any delays in the validation process:

  • Create potential patient safety risks for safeguarding and access to wider health and cancer screening services
  • Risk the GP practice not receiving correct patient payments

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FAQs

 

Please notify PCSE a week before the change takes place so that we can arrange to turn the GP Links off. 

Click below to access our online form to notify us of your change of clinical system. 

PCSE will confirm the highest transaction number as this will need to be passed on to your new Clinical System Supplier so that they can increase the Practice Transaction Numbers to prevent duplications occurring, which can occur with system changes.

Please do not attempt to send any registrations through the GP links until the GP links are turned back on (go live date).

If you have any queries regarding system migration please contact pcse.linkconfirmations@nhs.net

Yes.  If you move to a new practice, a new GP code will be issued to you as part of the Performers List change  notification process.  Please do not use your old GP code once you move to a new practice, as this would result in new  patient registrations being assigned to your previous practice, and the patient’s medical records would be sent to your previous practice.   Details on the performers list change notification process can be found here.

Guidance on how to register potential blood and organ donors on NHAIS can be found here.

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