Admin: Subject Access Request (SARs) - Clarendon Lodge Medical Practice

Please complete the form below if you wish to access your health record as set out in the General Data Protection Regulations 2018.

In Accordance with Article 12 of the GDPR 2016 - Copies of medical records will be made available to you within one month of your request (this period of compliance can be extended by a further two months where requests are determined to be ‘complex’ or ‘numerous’).

You will be expected to collect your records from Clarendon Lodge Medical Practice when they are ready – you will be informed by text or email.

We will require you to bring a photographic form of identification for Reception to check when collecting your medical records.

A reasonable fee based on the organisations administration costs may be charged for SARs in the following instances:

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. We will start to process your form by the next working day but it will take up to 30 working days to complete. Please DO NOT call before 30 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.

Admin: Subject Access Request (SARs)

Patient Name:

Date of Birth (DD/MM/YYYY):

Full Address:

Email Address:

I wish to access my health record as set out in the General Data Protection Regulations (2018). I wish to access:

Declaration - I decalre that the information given by me is correct to the best of my knowledge and I am entitled to apply to access my health recordsreferred to above under the terms of the Access to Health Records Act 1990. Please choose:

If a specific part of you medical record wanted please state further details to explain which part you require:

We can provide copies of your records in the following way: (Please select appropriate option)

I declare that the information given by me is correct to the best of my knowledge and that I am entitled to apply for access to the Health Records referred to above under the terms of GDPR 2018. (COMPULSORY: Please select appropriate option)

I am the patient

I have been asked to act by the patient and attach the patient’s written authorisation

I am acting in loco parentis and the patient is under the age of 16 years (and is incapable of understanding the request/has consented to my making this request).

Name and Contact Number (IF NOT the patient)

I also understand that no clinical opinion can be given with regards to viewing my health record as a clinician will not be available to oversee the viewing.

Medical Records Access Questionnaire

Have you read the Guide for Patients on viewing your medical records online?Link to document above

The system allows you to see a summary of your medical record: diagnoses, allergies, medications, recent consultations, letters to the GP and test results. Are you happy to view this information?

You need two passwords, one to book online appointments and the second to access your medical record. Keep them safe and secure. You should not share your passwords. Do you agree this is safe and secure enough?

You may see that a test result is reported as ‘abnormal’ or information about you that concerns you.

For example, you may have seen a hospital doctor who will write to your GP. You may read information in their letter that you do not understand or you find upsetting.

You may have a test done that shows something ‘bad’ that you were not expecting. (e.g. an x-ray report which shows you have a ‘shadow’ on your lungs). You may be reading these results/letters when the surgery is closed, in the evening or at the weekend, before the GP has accessed them.

How do you think you would you react in these circumstances?

Open results and make a routine appointment to see the doctor/nurse to discuss my concerns

Not view an abnormal result but make an appointment to see the doctor/nurse

Panic and get worked up if surgery is closed

Look at some of the recommended websites

Contact NHS Direct to get further information

Contact the Out of Hours Service

Other

If other please state:

Sometimes information may be recorded that is incorrect or there may be information that you think is missing. Would you inform the practice so that your records can be corrected?

Do you feel you have a better understanding of ‘Medical Records Access’ and what the issues are about it?

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.