Simulated workplaceCAQA Lakeside Health is a fictional business created by CAQA for training and assessment. It is not a real company and no person, client or record here is real.About this simulation
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CAQA Lakeside Health · Simulated workplace

New Patient Registration and Consent Form

FormControlled document
LAK-FRM-002
v3.0
Document ownerPractice Manager
Version3.0
Approved18 March 2026
Next review18 March 2027
StatusCurrent

Purpose. New patients complete this form so that Lakeside can register them correctly, record who else is involved in their care, capture allergies and emergency contacts and obtain consent to collect and share their health information.

1.Before the patient completes it

Give the form to the patient with the privacy collection statement and offer help to complete it. Offer an interpreter or a large-print version where needed. A parent or guardian completes the form for a child, and a person with authority completes it for a patient who cannot.

2.Checking the form

Reception must check that every mandatory field is complete and legible, verify the name, date of birth and address against identification and confirm the healthcare card or concession details. Do not accept a form without the consent section signed.

3.Entering the record

Enter the details into the Patient Records and Appointments system exactly as written on the form, then scan the form to the record and shred the paper. Add alerts for allergies, the need for an interpreter, a carer or guardian and any shared name.

4.Consent

The consent section records the patient's agreement to Lakeside collecting, using and sharing their information for their care, their choice about the national electronic health record and their preferences for reminders and recalls. The patient can change these choices at any time by telling reception.

5.Retention

The scanned form is part of the patient record and is retained for the same period. The paper form must not be filed, posted or left on the counter.

6.Complete the form

LAK-FRM-002 v3.0 · CAQA Lakeside HealthUncontrolled when printed. Simulated document created by CAQA for training and assessment.