Consent and questionaires

PATIENT CONSENT TO ENTER DATA IN THE BRITISH SOCIETY OF UROGYNAECOLOGY DATABASE

Dear patient,

The British Society of Urogynaecology (“BSUG”) is a national group of gynaecologists with a special interest and expertise in the treatment of incontinence and prolapse. BSUG has developed a database of clinical and surgical data for the purposes of publishing anonymous statistical information for research purposes and to enable individual NHS Trusts and consultants to audit information about operations to ensure that the procedures performed at their hospitals are as safe and effective as possible.

Before reading on, please indicate that you have read and understood the patient information sheet relating to the BSUG database by ticking this box:

The patient information held in the BSUG database comprises name, hospital number and date of birth, together with clinical and surgical information (“Patient Identifiable Data”). Because this information is confidential to each patient and is that patient’s personal data within the meaning of the Data Protection Act 1998, we do not disclose Patient Identifiable Data to BSUG without written consent.

If you agree to allow us to enter your Patient Identifiable Data into the BSUG database, please sign at the end of this document. This will signify your consent to the following:

Consent

I consent to the disclosure of my Patient Identifiable Data to BSUG Database Limited (“BSUGDL”) on the condition that BSUGDL undertakes not to use or disclosure my Patient Identifiable Data except in accordance with the next section.

Consents to BSUGDL

I consent to:

  1. the processing of my Patient Identifiable Data for the research and auditing purposes described in this letter.
  2. the disclosure by BSUGDL of my Patient Identifiable Data to its IT Service Provider or any future IT Service Provider, where such IT Service Provider has: 
    1. agreed to adopt appropriate technical and organisation measures to protect the security of my Patient Identifiable Data and only to process it in accordance with BSUGDL’s instructions;
    2. been instructed NOT to store my Patient Identifiable Data on a server which is located outside of the United Kingdom; and
    3. been informed of the existence of my legal right to confidence in respect of my Patient Identifiable Data.
  3. the disclosure of my Patient Identifiable Data to the consultant team (and the NHS Trust employing that consultant team) who disclosed it to BSUG.
  4. the disclosure of my Patient Identifiable Data to BSUG or any legal entity which is wholly owned by BSUG, for processing in accordance with the consents in this section.

Please note that you can request access to view your entry on the BSUG database from your consultant team and can request that this is deleted at any time by sending a written notice to your consultant OR to the following address:

BSUG Database Limited

c/o BSUG, Royal College of Obstetricians & Gynaecologists 27 Sussex Place

Regents Park London NW1 4RG