Subject Access Request Application

Frequently Asked Questions

Question	Answer
Do I have a right to be provided with a copy of my Health Records?	Yes, under the EU and UK Law you have this right. Your request MUST be made in writing. You can do this by completing the attached form, which once completed and returned to us will give us the information we need to deal with your request.
Do I have to explain why I want a copy of my records?	No, you do not have to, however, giving us a brief explanation of why you want them will assist us in dealing with your request.
Do I have the right to be provided with a copy of another individuals Health Record?	Only if the individual you are requesting the records about is under the age of 16 and you have legal parental responsibility for them or you have been appointed by the court to manage that individuals affairs when they are unable to e.g. power of attorney. You will need to tell us why you want the records.
Do I have the right to a copy of a deceased persons Health Record?	The Access to Health Records Act 1990 provides certain individuals with a right of access to the health record of a deceased individual. These include the executor or administrator of the deceased person’s estate/will and a person who may have a claim arising out of the individual’s death. These requests will be assessed on a case by case bases
How long will it take for me to be provided with the records I request?	Under the EU and UK Law we are required to provide you with the records within one calendar month and under the Access to Health Records Act 1990 within 21 days. Where possible we aim to provide all requested records within 21 days or sooner.
Will I have to provide any identification?	Yes. You MUST send us copies of the documents listed on Section 5 of the form. Failure to send these will result in your request NOT being processed.
How will I receive the records?	This will depend on what information you are requesting. Most of the records we hold are now held electronically, so you may be provided with a disc. Records which cannot be provided on a disc will be sent to you in paper format.
What is the Secure Access portal?	It is a secure area to view and/or download your requested information. It allows for the secure sharing of sensitive information eliminating paper waste whilst increasing control, security and delivery times.

If you have any further questions or need assistance please undefined.

Part 1 of 5Who is this request for?

Note: If you are applying to access the records of more than one person e.g. those of you and your baby or Fertility records which will include your partner’s information, you must complete 2 separate forms. This will help to prevent delays in your request being processed.

Are you completing this form to: Access your own records Access records on behalf of someone else Solicitor access / other organisations

Which Hospital site does your request relate to?

Part 2 of 5Name and Address

Your name and address

Title Forename(s) Last name

Current address Post code

Email Mobile Landline

Patients name and address

Title Forename(s) Last name

Date of Birth Former/Maiden name

Hospital number (if known) NHS Number (if known)

Current / Last Known Address of Patient Post code

Previous address (Only required if at current address less than 6 months) Post code

Email for Patient/Representative Mobile for Patient/Representative Landline for Patient/Representative

Part 3 of 5Medical Records

Part 4 of 5Proof of Identity Documents

Select one statement below and upload three supporting documents as described.

I am requesting access to information about a person who is under the age of 13 who I have parental responsibility for.

-	Their Birth certificate or Adoption certificate or proof of custody/responsibility.
-	A valid photo ID that includes your signature, such as a passport or driving licence.
-	A document showing your name and current address, such as a utility bill, bank statement, or hospital letter. (Please black out any financial details if necessary.)

I am requesting access to information about a person for who I have Power of Attorney or a Court Order of Protection.

-	A copy of the signed Power of Attorney document
-	A valid photo ID that includes your signature, such as a passport or driving licence.
-	A document showing your name and current address, such as a utility bill, bank statement, or hospital letter. (Please black out any financial details if necessary.)

I am requesting access to information about a deceased person for who I am Executor of their Estate or Administrator of their Will.

-	An official document or letter which lists you as the Executor of their Estate or Administrator of the Will
-	A valid photo ID that includes your signature, such as a passport or driving licence.
-	A document showing your name and current address, such as a utility bill, bank statement, or hospital letter. (Please black out any financial details if necessary.)

Your ID Document(s)

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1 ID Document(s) required.

Part 5 of 5Declaration and Submit Application

⚠️ Warning: It is a criminal offence to make a false or misleading request to gain access to personal information.

Declaration:
I confirm that the information provided in this application is true and accurate to the best of my knowledge.

By signing below, you confirm that:

The information you have provided on this form is correct.
The documents you are submitting are true copies of genuine originals.

Dated Signature