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Medical Records Access Request Form
(Deceased Patients)

Information for Applicants

 

Please consider the information below before completing the Application for Access to Confidential GP Health Records form for a deceased patient.

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  • Access to medical records is governed by the Access to Health Records Act 1990

  • We will endeavour to deal with your application within 40 days, in accordance with the Access to Health Records Act 1990.

  • The practice as the holder of the records retains these for 10 years after death

  • The Access to Medical Records Act 1990 specifies who can lawfully obtain access to the records of a deceased patient

  • We can only provide copies of health records which we hold. Parts of a person’s medical record may be held with hospital, community or mental health trusts. We cannot provide access to these records, and you therefore may wish to make a separate application to another health organisation.

  • S. 5 (4) of the Access to Health records state that parts of records should only be released which are relevant to the request. You may find that you request all notes of the deceased patient and only receive what is relevant to the reason why the records are required. This is the decision of the health professional in our practice in line with the legislation.

 

People who can apply for access to a deceased person’s medical records:

 

  • An individual who has been given a court order to do so

  • A deceased patient’s personal representative: the executor of their will, or

  • A named administrator of their estate if there is no will

  • Someone who may have a claim arising from the death of the patient

  • A legal representative of any of the above

Thanks for submitting!

*This form is for Modality Partnership Patients Only and must be completed and signed in order for us to process your request*

Section 1: Your Details

Are you:

Section 2: The Deceased

Section 3: Your Relationship to the Deceased

Please be as specific as possible. This helps us provide the information quickly and reduces delays.

Sources of information to include: (Tick only one) Obligatoire
Upload any supporting documents
Upload supported file (Max 15MB)

Section 4: What Records are you Requesting?

Please tick one option: Obligatoire

Section 5: Proof of Identity 

To keep the information of the deceased safe, we need to confirm your proof that you can access these records. The documents must be original and not photocopies.

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  • Court order

  • The will of the deceased

  • An order for probate

  • A summary of the claim that you are considering.

Section 6: Declaration

I declare that the information given by me is correct to the best of my knowledge and that I am entitled to apply for access to the health records referred to above under the terms of the General Data Protection Regulations.

I am requesting: (Tick all that apply)

Section 5: How Would you Like to Receive the Information?

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