Request for Letters – Forms – Records Patient Authority Consent Form Access to Health Records under the Data Protection Act 2017 (Subject Access Request) Name First Last Address Street Address Address Line 2 City Postcode Contact NumberDate of Birth Day Month Year Please read carefully and clearly indicate which you are requesting You will need a proof of photo ID and proof of address. Requests will be actioned within 30 days. – Access to online records (able to view your records online) Patient NHS App Register: www.arcadiangardenssurgery.nhs.uk/online-services/ and obtain PIN from Reception. – Single sheet e.g.: printed results / immunisations history – Brief Medical Summary (includes medication list, active problem list, some results) – Administrative Letter (Confirmation of registration, University letter) – Full Medical Records (a printout of medical history including documents). Request via: www.arcadiangardenssurgery.nhs.uk/policies/subject-access-request-form/ – Medical Report (a detailed report written by your GP which incurs a charge determined by the doctor)Reason for your requestAny information you provide will be helpful to us processing your request.Proof of photo ID and proof of address Drop files here or Select files Max. file size: 50 MB. Under the Data Protection Act 2017 you do not have to give a reason for applying access to your health records. However, to help us save time and resources, if you wish, it would be helpful if you could provide details, informing us of periods and parts of your health record you require, along with details which you may feel have relevance i.e., consultant name and location etc. PLEASE TAKE NOTE: Fees for reports are at the GP’s discretion and can be subject to change. Charges to costs are determined by the time needed to complete this request and the amount of information needed.
