Subject Access Request (SAR)

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Data - You will appreciate that health data relating to any individual is highly confidential and the Practice must ensure that it releases such data only to the person to whom it relates, or to a person authorised to act on his or her behalf. If you require any health data, please complete this Request Form as fully and accurately as possible to enable us to locate the exact information you require.

Timescales - The Practice will deal with your request as quickly as possible. If you request copies of all or part of your medical record, these will be ready within the allocated timescales specified by the Regulations (which is currently 28 days from receipt of your accurately completed form and confirmation of consent). Under certain circumstances, this period can be extended to 3 months. Please note that if you select Summary report of your medical records – we will provide this information within 7 working days.

Fees - We will not make a charge for the first request for access to your medical records. We may, however, charge for subsequent requests or if we deem that the volume of information requested is excessive.

All questions marked with a * are mandatory

I am: *
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Applicant's Details
Patient's Details
Please included any former names
Please double check you've entered the correct email address

Help Us To Help You 

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources. 

How to find your NHS Number 

If known
Would there have been a former postal address we would have on record?: *
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Additional Information

Under the Data Protection Act you do not have to provide a reason for applying for access to health records.

  • However to help us save time and resources, it would be helpful if you could provide details informing us of periods and parts of the health records you require access to, along with details which you may feel are relevant
e.g. radiology results, information relating to a specific accident
Proof of Authority

If you are making an application on the behalf of somebody else we require evidence of your authority

Please upload a copy of your evidence

  • You can upload a document, photo or scan
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Details of where medical records are to be sent
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Declaration

You are requesting access to the records for

  • Name: 
  • NHS Number: 

Please return to the previous pages to make any amendments

  • 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 one calendar month 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.

You can upload any ID below to support with your request. We recommend photo identification (e.g. a passport or driving licence) along with proof of address (such as a utility bill).

Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
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Privacy Consent

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