RFI

Workflow /

Patient Information being requested

Please enter the details of the patient information being requested.
If you are not the patient, you will be asked to enter your details on the next page.

First name and Surname

Person Requesting the Patient Records

Please attach a copy of the patient’s written consent/legal documentation authorising you to request information on the patient’s behalf, which can be done at the bottom of the form before submitting. Note: For other NHS Organisations, please provide the name of your organisation, and your contact details, i.e., email address and telephone number.

Person Requesting the Information

Your Company Reference Number

Your Job Title

Notifications

Stages

Solicitors

Request Details

Please answer as fully as possible. The fields in orange are mandatory and MUST be completed for this form to be saved.

Stop Clock

Completed

Type of Request

Method Received

Days Required

Target Date

Date Received

Time Received

Request Date

Response Due Date

Acknowleged

Summary (Brief Details)

Hospital Site

Response Format Required

Response Date

Extension Reason

Handler

Source

Estimate Of Time (hrs)

Estimate Of Time (mins)

Status

Request wide location info

Organisation

Locality 2

Locality 3

Site

Site Type

Department

Specialty

Locality 1

Locality 2

Notes

Please detail the information being requested

Please click the +New button for each additional type of record being requested.

Send Email

Specialty (if known)

record	unique	DPA Type	Additional Info.	Del.

Please provide any other information that will assist with processing this request

Attachments and Documentation

The Trust needs 2 proofs of identification - 1 needs to be photographic ID e.g. passport, driving licence and 1 proof of address dated within the last 3 months e.g. utility bill, bank/credit card statement.
If requesting on behalf of a patient, please provide a copy of their written and signed consent (their ID is not required when consent is provided) .
If the request for information relates to a child under the age of 16 we'd need a copy of their birth certificate naming the parent(s). Over the age 16 the child needs to consent for themselves.
For requests relating to a deceased patient this is handled under a different process on a case by case basis.

Add Attachments

Document	Date Added	Time Added	Entered By	Delete

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