Subject Access Request

If you need to submit a Subject Access Request, please use this form.

If you are human, leave this field blank.

Which practice are you registered with? *

Kingsclere Medical Practice

Oakley Surgery

Overton Surgery

NHS Number (if known):

Address: *

Please select one of the following: *

Full record

Extract

Please inform us of certain periods and parts of the health record you may require, or provide more information about your request. This may include specific dates, consultant name and location, and parts of the records you require e.g. written diagnosis and reports. *

Records will be prepared and sent to you by Medi2data.

Under the GDPR you do not have to give a reason for applying for access to your health records.

You will be asked to provide photographic identification.

I confirm that I am the data subject named above (the person that the data is about)

Patient Signature: *

Date:

Counter Signature (if applicable):

Consent for children under 16 (Gillick Competence)

Everyone aged 16 or more is presumed to be competent to give consent for themselves, unless the opposite is demonstrated. If a child under the age of 16 has "sufficient understanding and intelligence to enable him/her to understand fully what is proposed" (known as Gillick Competence), then they will be competent to give consent for him/herself. Young people aged 16 and 17, and legally 'competent' younger children, may therefore sign this Consent Form for themselves, but may wish a parent to countersign as well. If the child is not able to give consent for themselves, someone with parental responsibility should do so on their behalf by signing this form.

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Consent for children under 16 (Gillick Competence)

Statement on Accessing the Practice