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Access My Records2020-10-16T12:53:03+01:00

Please read the accompanying guidance: “Access to Health Records Information Leaflet” regarding the rights of access together with charges that may be associated with your application, to assist you in completing this application form.



    I am the patient and over the age of 16 years.
    I am the person who has legal responsibility for the patient, who is under the age of 14.
    The patient is over 14 years of age and under 16 years of age, has consented to my making this request and has authorised my application.
    I am acting on behalf of the patient (aged over 16). Please be advised that you will need to provide proof that you have power of attorney or that you are the legal representative.
    I am the deceased patient’s personal representative and attach either letters of administration or a grant of probate.
    I have a claim arising from the patient’s death and wish to access information relevant to my claim on the grounds that:

    Unless you have requested paper copies, records will be sent out to you via an delivery system. The password to open this document will be emailed to you.


    If the name and / or address were different from above during the time period(s) to which the application relates - please give details below:

    PREVIOUS DETAILS: Heading 1 Heading 2

    To help the NHS save time and resources it would be helpful if you could provide details below, informing us of the parts of the health records you require, along with details which you may feel have relevance i.e. dates, consultant name, location, written diagnosis and reports etc.

    Please use the space below to document, continuing on another page if necessary

    WWL Hospital Services (Royal Albert Edward Infirmary, Leigh, Wrightington, Thomas Linacre, Boston House)
    WWL Community Services (Walk In Centre, District Nurse, Mental Health etc.)

    WWL Services:
    WWL HOSPITAL / CLINIC CONTACTS (Please provide as much information as possible)
    Date Attended Hospital Ward / Clinic Consultant Type of Record
    – please indicate
    Hospital No
    Case notesX-raysA&E RecordsPhotographs
    Case notesX-raysA&E RecordsPhotographs
    Case notesX-raysA&E RecordsPhotographs
    WWL Community:
    WWL COMMUNITY CONTACTS (please provide as much information as possible)





    I declare that the information supplied above is correct to the best of my knowledge and that I am entitled to apply for access to the above record(s) under the terms of the Data Protection Act 2018. I enclose two forms of identification one of which must be a photocopy of photographic identification; the other must be a utility bill:

    We cannot process your application without proof of identity.

    Please return this form to:-

    Access to Health Records Department
    Knowsley House
    Wigan Lane
    WN1 2NN
    Tel:- 01942 822541