This form is for use by Park Lane registered patients only.
JS Medical Practice will normally respond to a Subject Access Request within one month of receipt. We may extend the time limit by a further two months if the request is complex or if we receive a number of requests from the individual. This period will not commence until JS Medical Practice is satisfied as to the identity and authority of the applicant. JS Medical Practice may seek further information from the applicant as to the specific information requested. Any request for clarification will suspend the one month period until the required information is received. There is no fee charged for this request. However, we may charge a ’reasonable fee’ for the administrative costs of complying with a request if it is manifestly unfounded or excessive, or if an individual requests further copies of their data.
1. Details of person requesting information (the Applicant):
Details of person acting on behalf of the data subject (applicant).
4. Please give details as to the information you would like to review.
The Practice uses ‘emr by medi2data
’ and ‘iGPR
’ (IT data processing services) to help us process subject access requests for patient records, ensuring GDPR is followed. The advantage for the practice using these services are that medical records can be presented in a format that can be easily read and understood, sensitive data can be redacted (edited, removed) if needed (please inform us of any information you wish to redact), whilst following strict information governance and data protection procedures. Emr by medi2data and iGPR are bound by strict data protection policies and your medical record will not be viewed or shared by emr and iGPR. *Please note emr by medi2data uses a two-step authentication process for added security. You will be sent a verification code via your mobile phone in order to access and download your medical record securely online via emr. If you do not have access to email, please inform us. Please also ensure your email server allows the email address, email@example.com
as you will receive the medical records through here.
Please provide the following proof of Identity and authorisation from the Data Subject:
- Driving licence or, Passport or birth certificate of the data subject.
- Proof of address, e.g. a utility bill (no longer than 3 months old) of the data subject.
And if relevant:
- A signed letter of authorisation from the data subject consenting that the solicitor can act on their behalf or Lasting Power Attorney.
Max. file size: 50 MB, Max. files: 20.
Drop files here or