Once you have confirmed an appointment with a GP regarding a skin condition then please complete the following form and attach requested photographs which will be reviewed before your telephone consultation.
Dermatology Consultation Form
Please email the completed form and photographs to: firstname.lastname@example.org
Thanks you for agreeing to send your images or files. These will be reviewed by a clinician and where they have been used to make decisions about your care, will be stored as part of your medical record. These files will only be kept as part of your medical record and will not be used for any other reason. If we need to refer you to other NHS services, the files will be available for them to view.
PLEASE NOTE THAT THIS EMAIL ADDRESS CAN ONLY BE USED FOR THIS ENCOUNTER. PLEASE DO NOT USE IT FOR ANY OTHER COMMUNICATION AND DO NOT USE UNLESS YOU HAVE BEEN ASKED TO DO SO.
For us to process the request correctly please include the following information:
Full name of patient to be uploaded:
Date of Birth:
CHI No. if known:
Area of body photographed:
Sending the email, with the requested files attached, will signify that you the parent/carer/next of kin understand that the images/files will be added to your/their electronic health record and be used to aid in identifying your/their diagnosis as part of a virtual consultation. The image(s) will be stored as part of your/their electronic health record in line with NHS GGC retention management guidelines.
Guidance for taking images:
- Use a camera or mobile device you are comfortable using. No need to go and purchase a new camera. If there is the option, set camera to the highest image quality possible.
- If possible, have somebody else take the images.
- Lighting, make sure you are in a well-lit area or use the device's flash.
- Background, make sure that you are not stood in front of a window/bright light and that there is nothing in the background (no clutter).
- Location shot, take a photo to show where on your body the area is, only include the relevant part of the body. For example, if the area of interest is on the back try to have only the back in the photograph. This might mean moving closer or further away to get it right. If the area of interest is hard to see draw an arrow on the skin to indicate where it is. If there is more than one reason you that needs to be photographed take a separate photograph for each body part.
- Close up, if necessary take a more detailed image closer to the area but not so close that your device cant focus. If possible include something that will give a sense of scale; a ruler would be great or try something of a known size like a 5p coin.
- Framed correctly, take the image straight on and make sure you leave enough space around the area, so you don't miss any of it.
- All images in focus, don't get too close and make sure the image is in focus.