Make a Subject Access Request

In order to protect the privacy of the Data Subject (individual) who this request is about and in line with the requirements of data protection & confidentiality legislation, North Bristol NHS Trust needs to ensure we locate the records and information only relating to the Data Subject. 

A Subject Access Request can be made by:

  • Completing and submitting the Make a Subject Access Request online form below 
  • By downloading and completing the FileSubject Access Request.docx and emailing or posting, along with your supporting documents. Email/postal details can be found within the document.

Who is completing the form?

Details of the Data Subject

Please fill in your details (the data subject). If you are not the data subject and you are applying on behalf of someone else, please fill in the details of the data subject below and not your own.

Proof of identity

We require proof of identity before we can disclose personal data. Proof of identity should include a confirmation of name e.g. full driving licence, passport, birth certificate, marriage certificate HSCIC identity card and confirmation of address e.g. utility bill, bank statement, credit card statement (dated within the last three months). 

If you have changed your name, please supply relevant documents evidencing the change. 

Please ensure all document file names contain the Data Subject's name and date of birth, for example, Dave Smith 22.05.2000 Birth Certificate.doc  

If you are acting on behalf of the data subject

Please complete this section of the form with your details if you are an authorised person acting on behalf of someone else i.e. the data subject. 

If you are NOT the data subject, but an agent/authorised person appointed on their behalf, you will need to provide evidence of your name e.g. full driving licence, passport, birth certificate, marriage certificate HSCIC identity card and confirmation of address e.g. utility bill, bank statement, credit card statement (dated within the last three months) as well proof of your right to act on their behalf e.g. Health and Welfare Lasting Power of Attorney, letter of authority, evidence of parental responsibility. 

Please ensure all document file names contain your name and the Data Subject's name and date of birth, for example, Dave Smith 22.05.2000 Birth Certificate.doc.

Dispatch

Please provide 3rd party details for dispatch.

Checklist

Declaration

Warning: a person who unlawfully obtains or attempts to obtain data is guilty of a criminal offence and is liable to prosecution.

Unless there is Health and Welfare Lasting Power of Attorney or the application is being made on behalf of a child under the age of 13, all persons named on this form should confirm that the information that has been supplied in this application is correct and you are the person to whom it relates or acting on behalf of.