Access to medical records

This form allows registered patients of Harwood Group Practice to request access to their medical records in accordance with the Data Protection Act 2018 and GDPR.

Before you begin, please note:

Purpose: You can use this form to request a copy of your medical records, access specific information within your record, or request online access to your detailed coded record if not already enabled.
NHS app: For routine access to your summary record, appointments, and prescriptions, we encourage you to use the NHS App. This form is primarily for more detailed or specific requests.
Accurate information: Please ensure all information provided in this form, especially your contact details, is accurate and up-to-date.
Contact details are essential: We will use the contact details you provide to communicate with you about your request (eg - for you to send your verification documents, or when your records are ready for collection). If we cannot reach you due to missing or incorrect contact information, you may need to visit the surgery in person to follow up on your request and arrange collection.
Processing time: We aim to process requests within one calendar month from the date of receiving a valid application and any required identification. In some complex cases, this may be extended as permitted by law, and we will inform you if this is the case.
Confidentiality: Harwood Group Practice is committed to protecting your privacy. All information provided and records released are handled with the strictest confidentiality.
Collection: Please be aware that identification will be required when collecting your records. Further details will be provided within the form.

Patient Details

To verify your request - It is important that we have either an up-to-date mobile telephone number or email address.

Title *

Forename *

Surname *

Date of birth *

Address *

Postcode *

Telephone Number

NHS Number (If Known)

Record requested by patient

Please tick the relevant boxes. The more specific that you can be, the easier it is for us to quickly provide you with the records requested.

Record you are requesting *

I am applying for access to view my records only (From November 2023)

I am applying for a printed copy of my medical record

What information are you requesting? *

Further Information (Dates or condition if you selected answer (A) or (B) in previous answer)

Collection of Medical Records

Important: Please read before arranging collection.

To ensure the confidentiality and security of your personal information, please note the following:

Identification of the collector required: The individual physically collecting the medical records MUST present their own valid photo identification (e.g., driving licence, passport) at the time of collection. This is mandatory.

If the Patient is Collecting: You (the patient) must present your own valid photo ID.

If a Nominated Representative is collecting: The nominated representative must present their own valid photo ID.

Failure to comply: We take patient confidentiality very seriously. If the person collecting the records cannot provide the required valid photo identification, the medical records will NOT be released. We appreciate your understanding and cooperation in safeguarding your personal data.

Who will be collecting the records?

I (the patient) will collect the records in person.

A nominated representative will collect the records on my behalf.

Name of the person who will collect the records? (Must bring ID for this person)

Declaration & Consent

Declaration and Signature
By entering your name below, you confirm that the information provided in this form is complete, accurate, and truthful to the best of your knowledge. You acknowledge that providing false or misleading information may result in further action.

Signature (Full Name) *

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Page last reviewed: 09 May 2025
Page created: 25 March 2024