Subject Access Request Form

Generic form for patients to complete to request copies of medical records 

Last Updated: 13/08/2024

  • Subject access request form

    Date of birth:
    For example, 15 3 1984
    We usually send patient records via secure email. Are you happy for us to do this?
    Please confirm your relationship to the patient

  • By submitting this form you confirm that you have read the following:

    The UK General Data Protection Regulation (UK GDPR), which was implemented in the UK through the Data Protection Act 2018, gives individuals the right of access to their personal data from any health and care organisation that holds records on them. This right is commonly referred to as ‘subject access’. We have a duty to respond to your request within one calendar month from the date of the request,  however if additional information is needed before copies can be supplied, in such cases, the 28-day time limit will begin as soon as the additional information has been received. The 28-day time-limit can be extended for two months for complex or numerous requests where the data controller needs more time to collate and supply the data. If a request is ‘manifestly unfounded or excessive’, for example, because it is repetitive, access can be refused, or a fee may be charged. For requests please be aware whilst we endeavour to complete subject access requests under 28 days, however this may not always be possible. Please tick below to confirm you have read and understood this statement
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