Generic Medical Records Request Form Template for England and Wales

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Key Requirements PROMPT example:

Generic Medical Records Request Form

"I need a Generic Medical Records Request Form to obtain my complete medical history from multiple NHS providers for an upcoming insurance claim, with specific focus on records from January 2025 onwards and the ability to authorize my insurance company to receive the records directly."

Document background

The Generic Medical Records Request Form serves as a standardized template for requesting medical records from healthcare providers in England and Wales. This document is designed to ensure compliance with UK data protection legislation while streamlining the process of accessing medical information. It includes necessary fields for patient identification, scope of records requested, and authorization verification, incorporating requirements from the Data Protection Act 2018 and UK GDPR. The form is particularly useful when individuals need to access their medical records for personal use, legal proceedings, or insurance purposes.

Suggested Sections

1. Patient Information: Full name, date of birth, NHS number, current address, and contact details of the patient whose records are being requested

2. Request Details: Specific information about the medical records being requested including date range, type of records, and format preferred

3. Purpose of Request: Statement of why the records are being requested (e.g., continuing care, personal records, legal proceedings)

4. Data Protection Notice: Information about how the requested data will be processed and protected under UK GDPR and Data Protection Act 2018

5. Declaration: Formal statement confirming the accuracy of information provided and understanding of the process

Optional Sections

1. Requestor Information: Details of person making request if different from patient, including relationship to patient and basis of authority to request

2. Capacity Statement: Required when patient lacks capacity under Mental Capacity Act 2005, including details of assessment and authority

3. Urgent Request Details: Section for indicating if expedited processing is needed and justification for urgency

4. Deceased Patient Information: Additional section required when requesting records of deceased patients under Access to Health Records Act 1990

Suggested Schedules

1. Schedule 1: Identity Verification Requirements: List of acceptable forms of ID and verification requirements

2. Schedule 2: Fee Schedule: Details of any applicable fees for different types of requests and payment methods

3. Schedule 3: Third Party Authorization Form: Template form for authorizing third party access to medical records

4. Schedule 4: Guidance Notes: Detailed instructions on completing the form and relevant legislative requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Authors

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