Application for Access to Health Records (Data Protection Act, 2018, Access to Health Records Act, 1990, General Data Protection Regulations (GDPR) and any other relevant Legislation).

Using the online form on this page is most secure way to make a request and send us your documents. However, if you prefer you can download a paper version. When completed, post it with copies of your identification documents to: Information Rights Team, Medical Records, 1st Floor office, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR.

Section 1 - the subject of this request

Please give the details of the person whose information is being requested.

Required
Required
Date of birth Required
Their address Required
Required

Section 2 - applicant's details

You only need to complete this section if the applicant's details are different from the subject named in Section 1. If they are the same, go to Section 3.

Address

Section 3 - upload your document(s)

Please check the box that applies to your request before uploading your document(s).
Required

Section 4 - records you are requesting

What information do you require and how should we disclose it to you?

Type of record

Section 5 - requests for staff information

The following question applies to current or former members of staff at Blackpool Teaching Hospitals only. If this does not apply to you, go to Section 6. 

If you are a current or former member of BTH staff, choose the record(s) you require.

Section 6 - declaration

I declare that the information provided on this form is correct to the best of my knowledge and I understand it is necessary for Blackpool Teaching Hospitals NHS Foundation Trust to confirm my identity.

Date Required
Required

The Data Protection Act 2018 and the General Data Protection Regulations (GDPR) give individuals the right of access, commonly referred to as subject access, it allows the right to obtain a copy of their personal data, as well as other supplementary information. It helps individuals to understand how and why you are using their data, and check you are doing it lawfully. 

  • Individuals have the right to access and receive a copy of their personal data, and other supplementary information in either Electronic, written, and verbal format
  • This is commonly referred to as a subject access request or SAR
  • Individuals can make SARs verbally or in writing, including via social media however if verbal further identification will be needed
  • A third party can also make a SAR on your behalf provided you have granted them permission in the form of signed consent or a legal document such as Lasting Power of Attorney
  • All information must be provided to the requester within 1 calendar month from the date the organisation has received your request unless this is deemed a complex SAR to which an organisation  can extend your request by a further two months. The individual must be informed within the first month of this decision
  • All requesters do have the right to complain to the Information Commissioners Office (ICO) if you are unhappy with the response to your SAR. You can access this via their website or call 0303 123 1113. You also have the right to seek a judicial remedy

Blackpool Teaching Hospitals NHS Foundation Trust has a duty as an organisation dealing with highly sensitive and confidential information to keep your personal information secure. We as an organisation will only provide information to you as the Data Subject or a third-party requester if we are satisfied, you’re the correct recipient of this information. Any information you have supplied in making this request will be treated in strict confidence.

Our Trust is only responsible for providing information, which is held by us. If your request indicates the release of information to a third party for example a solicitor or insurance company then a signed
consent form or other relevant proof of entitlement will be needed to authorise the release of your personal data.