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Access to my Health Records/Data

Please ensure you read and complete this application form carefully before submitting your request.

London North West Healthcare NHS Trust has a legal obligation to comply with the Right of Access associated with UK GDPR (see Data Protection Act 2018 and Access to Health Records Act 1990).

* Required

About You

* Forename

* Surname / Family Name

Any Previous Names (If Applicable)

* Current House Number / Name

* Current Road / Street

* Current Town / City

* Current Postcode

* Date of Birth

* Telephone

NHS Number (if known)

* Email

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Previous Addresses (if applicable)

House Number / Name Road / Street Town / City County Postcode

From To

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What Information Are You Requesting?
To speed up the process and reduce delays please provide as much information as you can to help us locate the information you are requesting.


* Which department/service are you aequesting the information from? -- Select -- Medical Records (Only) Radiology, Inc. MRI/CT/Scans (Only) Both (Medical Records & Radiology) Sexual Health (Only) Test Results (Only) Other

Other

* Which time period does your request cover? From To



We will need proof of your identity and residence before we can release any information.

* Proof of your identity (eg, scan of current passport, current driving licence, birth certificate, adoption certificate)

Document that confirms your address (eg, utility bill, bank statement, credit card statement)

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