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Subject Access Request (SAR)

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Brief Summary of Your Records

Also known as a Medical Summary from your GP. This summary is usually requested by a service when you have an appointment at a hospital or private clinic.
It includes the following information: Your full name, Date of birth, Address and contact details, NHS number, GP name, Active problems, Past problems (both significant and minor), Current medication, Allergies, Health status, Immunisations, Family history, Consultations.
If a person or company is requesting this on your behalf, they will need to complete a consent form specific to this request.
A Full summary will need to be reviewed by your GP.

Subject Access Request (SAR)

This is your full medical history and can either be requested from birth, or a specific date. This is usually requested for insurance purposes, court hearings or personal use. This will include all the medical information that we hold for you from your records, including attachments.
If a person or company is requesting this on your behalf, they will need to complete a consent form specific to this request.
This will need to be processed by our administration team and then reviewed by your GP and under the SAR Guidelines can take up to one calendar month.

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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

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Proof of Identity

Identification

We are required to check the identity of all applicants

Acceptable forms of Photo ID

Photo Driving License
Passport

ID documents are not stored and will be securely destroyed in line with our data retention schedule.

Acceptable forms of Proof of Residence

Tenancy agreement
Mortgage statement
Bank statement
Utility bill (date within the past 3 months)

Please upload a copy of your ID and Proof of Address

You can upload a document, photo or scan

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

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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

I would like access to:

ALL records held: *

Or specific records between:

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

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Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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