Cervical Screening Reinstate Form

Cervical Screening Reinstate Form Date: 1 November 2024 Patient Details: Name: Sarah Jenkins Date of Birth: 15/03/1988 NHS Number: 123 456 7890 Address: 12 Elm Street, Anytown, AB1 2CD Reason for Reinstatement: * Previous screening record incorrectly removed from system. * Patient has reached screening age after a period of being overseas and previously removed from programme. * Clinical decision by GP after review of patient history. Reason for Reinstatement: Previous screening record incorrectly removed from system. Date of Last Valid Cervical Screening: 10/05/2021 Result of Last Valid Cervical Screening: Normal Clinical Justification for Reinstatement: Following a review of Ms. Jenkins' medical records, it was identified that her previous cervical screening record, which showed a normal result on 10/05/2021, was inadvertently removed from the national screening system. There is no clinical indication to suggest that she should not continue with routine screening. The patient is otherwise healthy and within the eligible age range for the cervical screening programme. Reinstatement is necessary to ensure she receives appropriate future screening invitations. Clinician Details: Name: Dr. Eleanor Vance GMC Number: 9876543 Practice Name: City Medical Centre Contact Number: 01234 567890 Declaration: I confirm that the information provided above is accurate and that the reinstatement of this patient to the cervical screening programme is clinically appropriate. Signature of Clinician: Dr. Eleanor Vance Admin Use Only: Date Processed: 1 November 2024 Processed By: (Initialised by administrative staff) Confirmation of Reinstatement Sent to Patient: Yes