Non-NHS Private Work

What Information We Hold

We collect information from your medical records as part of our processes. You have the right to request access to this information free of charge. This is called Subject Access Request (SAR). However, in certain circumstances, such as repeated requests or when requesting private administrative services not covered by the NHS, a reasonable fee may apply. This includes services like medical letters, insurance forms, reports, and other non-NHS paperwork.

To make a request, please complete the form below.

How to Make a Private Work and Subject Access Request for Yourself

We require proof of your identity before we can disclose personal data. This should include copy of document such as:

  • Passport
  • UK Driving License (full or provisional)
  • European Driving Licence (full)
  • European National Identity Card
  • Birth Certificate
  • Marriage or Civil Partnership Certificate
  • NHS England Identity Badge

The documents should include your name, date of birth and current address. If you have changed your name, please supply relevant documents evidencing the change.

How to Make a Request for Someone Else

You can apply as a third party for someone that you are responsible for, including for a child, or for someone who has died. You will need to provide proof that you are allowed to act on their behalf. Health records are confidential so you can only access someone else’s records if you are authorised to do so.

Advice for Sending Requests to the Team

Due to the sensitive nature of the information needed to process your request, it would be preferable for us to receive your application via our secure online form, rather than via email and post. If you are unable or do not have access to internet, our postal address is on our website.

No Refund Policy

Please be advised that our Practice has a no refund policy for such items of work. The practice takes significant time and effort to process and action your request outside of their usual NHS duties. This time is accounted for in the fees, and therefore, once the practice starts any work on your request, a refund cannot be issued. By submitting a request for non-NHS private work, you are confirming the nature of the work you require, and that you accept the no refund policy.

Incomplete Applications

Incomplete applications will be returned, therefore, please ensure you have the correct documentation before submitting the form.

Our Response

We will usually process your request within 30 days. Following your request, we may write back to you within the 30-day time frame to request you to narrow or modify your requirements. This may also result in an extension of a further 60 days whilst we examine your request.

Information is provided in line with the General Data Protection Regulations (GDPR), Chapter 3, Article 15 (Recitals 63 & 64).

 

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Section 1: Details of the person this request is about

Section 1: Details of the Person this Request is about

Please tell us the details below about you, or the person you are applying on behalf of, so that we can check for the information we may hold:
Date of Birth*
Address*
Contact Preference*
If the request is for more than one person, please provide details for each additional person.First Name, Last Name, Date of Birth

Section 2: Written authority to act on behalf of the person you are making the request for

Section 2: Written authority to act on behalf of the person you are making the request for

This section should only be completed if you are making the request on behalf of someone else. If you are not the the person you are making the request for, but are acting on behalf of them, please tell us the details below. We need to know what gives you the authority to act on their behalf, so please state your relationship with them, for example, parent, solicitor, or holder of power of attorney.

Section 3: Proof of identity

Section 3: Proof of Identity

Please do not send any original documents. You can send printed copies or electronic copies. (The following list is not exhaustive).

Applying for yourself

If you are applying for yourself, we need to see:

• one document confirming your name, from Group A, below

Applying on behalf of someone else

If you are applying on behalf of someone else, we need to see:

• one document confirming your name, from Group A, below
• one document confirming the name of the person you are applying on behalf of, from Group A, below
• all documents needed to show that you have the authority to access the records, from Group B, below.

A. Documents that confirm your name:

• Passport
• UK Driving License (full or provisional)
• European Driving Licence (full)
• European National Identity Card
• Birth Certificate
• Marriage or Civil Partnership Certificate
• NHS England Identity Badge

B. Documents that confirm you are allowed to act on behalf of the person you are making the request for:

• Health and Welfare Lasting Power of Attorney
• Court of Protection Order appointing you as a personal deputy for the personal welfare of the Subject
• Full Birth Certificate of Child
• Full Certificate of Adoption
• Parental Responsibility Order
• Signed Declaration from the person you are making the request for

We may get in touch with you for further information.
Drop files here or
Max. file size: 128 MB.
    Max. file size: 128 MB.

    Section 4: The nature of your request

    Section 4: Type of Request
    I am submitting a request for:*

    Section 5: Helping us to find the information

    Section 5: Helping Us to Find the Information
    Please use the space below to provide details that may help to locate your information. Being clear about the information you require will help us to respond promptly to your request. Please supply as much detail as possible. Please specify the reason if requesting a letter. If related to a specific injury, please provide dates of injury and hospital attendance.
    Drop files here or
    Max. file size: 128 MB.

      Section 6: Where you would like the copies of your information to be sent

      Section 6: Where You Would Like the Copies of Your Information to Be Sent

      Our preferred method of delivery is via email. Any documents will be sent securely.

      If you would like to get your information by post, please note that information posted by special delivery will need a signature upon receipt. However, if the Royal Mail are unable to deliver to the address given and need to return the documentation to us this will be returned by normal post (that is, not securely).

      Please tell us where you would like your information sent:*

      Section 7: Declaration

      Section 7: Declaration

      Unless there is Health and Welfare Lasting Power of Attorney or the application is being made on behalf of a child who is unable to make the request themselves, everyone named on this form should sign below.

      I confirm that the information that I have supplied in this application is correct, and I am the person to whom it relates, or I am acting on behalf of the person this request is for and have enclosed the relevant proof of authority as detailed in Section 3.

      Knowingly or recklessly obtaining or disclosing personal data is an offence under data protection legislation. By signing this form, you are giving agreement that your personal data (or that of the person you are acting on behalf of) can be shared within NHS England in order that we may process your request and provide you with the information sought.

      Your personal data will be kept in accordance with NHS England Retention and Destruction procedures.
      Please select*
      Date*

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