Application Form For Access To Health Records - Subject Access Request
Who are you completing this form on behalf of? *

Patient Details

Applicant Details

Record Requested
Can we refuse to comply with a request?
We can refuse to comply with a subject access request if it is manifestly unfounded or excessive, taking into account whether the request is repetitive in nature. If we consider that a request is manifestly unfounded or excessive we can:
• request a "reasonable fee" to deal with the request; or
• refuse to deal with the request.
In either circumstance we will justify our decision. If we decide to charge a fee we will contact you promptly and inform you of the likely costs. We do not need to comply with the request until the fee is received.

How long do we have to comply?
We will act on the subject access request without undue delay and at the latest within one month of receipt. We will calculate the time limit from the day after we receive the request (whether the day after is a working day or not) until the corresponding calendar date in the next month.

Can we extend the time for a response?
We can extend the time to respond by a further two months if the request is complex or we have received a number of requests from the patient. We will let you know within one month of receiving your request and explain why the extension is necessary.

Declaration *

Please note that proof of identity will be required before SAR is granted.

Please note that written authorisation from the patient will be required before SAR is granted.

Please note that a certified copy of the court order will be required before SAR is granted.

Please note that grant of probate/letters of administration will be required before SAR is granted.

Please note that proof of appointment will be required before SAR is granted.