Examples of an eConsent form

Homepage

The Homepage gives parents information on the vaccine and requests parents to complete the form. It contains a set of FAQs and contact details of the Immunisations team managing the programme. 

School selection page

 Here the parent selects the school using the name or location. A dropdown appears with the options.  

Child details 

Having selected a school, the parent/guardian fills in demographic details of the child being immunised, including their address. 

This will initiate an NHS Mini Spine lookup which will match the child's demographic details and find the child's NHS number. If the demographics match this will be auto populated in the patient details.

Parent/Guardian details 

 The parent/guardian then completes their details 

Providing consent 

Next, the parent will indicate yes/no to consent. If no is selected, a dropdown will ask for a reason, and a record will be created in RIVIAM. If yes, they move on to the next section. 

Child's health history 

This section captures key information about any underlying conditions or allergies. Any yes answers will trigger a request for further information captured in the patient record on RIVIAM for Triage. 

Confirmation page

Having completed the form, the parent will see a confirmation message containing a referral number and confirmation of the consent submitted will be emailed to the email address provided.

RIVIAM can also send the parent a copy of the referral document if required by the customer.