Medical Records Request


A Subject Access Request (SAR) allows you to obtain access to the personal information he practice holds about you, such as your medical records. Under data protection laws, you have the right to understand what data is being collected, how it is being used, and with whom it is shared. To initiate a SAR, you must submit a formal request, typically accompanied by proof of identity. Please note that processing your request may take up to 30 days, after which the medical secretary will contact you to arrange collection.

Please fill out the Subject Access Request form below.

Subject Access Request Form

I am

Patient's Details

Name
Name
DD slash MM slash YYYY
Address
Max. file size: 50 MB.
Please note acceptable forms of ID are Photo Driving License or Passport.
Max. file size: 50 MB.
Please note acceptable forms of Proof of Address include Tenancy agreement, Mortgage Statement, Bank Statement (dated within the last 3 months) or Utility Bills (dated within the last 3 months).

Additional Information

Under the Data Protection Act, you are not required to provide a reason for requesting access to medical records. Nevertheless, to assist us in saving time and resources, it would be appreciated if you could indicate the specific periods and sections of the health records you need, as well as any other details you consider relevant.
DD slash MM slash YYYY
DD slash MM slash YYYY

Declaration

If there is any doubt about the applicant’s identity or entitlement, information will not be released until further evidence is provided. You will be informed if this is the case. Under the terms of the Data Protection Act, Subject Access Requests will be responded to within 30 days after receiving all necessary information and/or fee required to process the request. Under the terms of Section 7 of the Data Protection Act, Information disclosed under a Subject Access Request may have information removed; this is to ensure that the confidentiality is maintained for third parties referred to who have not consented to their information being disclosed. Please note that we will contact the patient by telephone (using the information on their records) to verify the patients request and identity.
Consent