NUH NHS Portal – Data Requests

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Please answer the questions below which will determine which form of request is required and the information we will need.

Are you: *

A patient or individual requesting your own data (Subject Access Request)
Requesting access to someone else’s data, including those of a deceased patient (Subject Access Request / Access to Health Records) (Individuals / Solicitors)
A public body requesting information on somebody else’s data? (Police, Fire Service, NHS, Local Authority etc.) (A Schedule 2 Request, previously known as a Section 29)
A journalist or an individual requesting organisational information? (Using the Freedom of Information Request)

Please note red starred items are mandatory.

Complete on any device: This form can be completed on a computer, tablet or mobile phone. You may find electronically signing the form easier on a touchscreen device or using a stylus.

Your Data

You have a right to be told whether we hold any information about you, and a right to be provided with a copy of that information within one calendar month (a maximum of three calendar months in some circumstances, we will inform you if this is the case). In order to do this please answer the following questions carefully and provide the following listed items. Please see the Guidance on providing supporting documentation (ID) if you are unsure.
You will need:

Proof of your identity (such as Driving Licence or Passport with photo)
Proof of your current address (such as Utility or Bank Statement in last 3 months)

If after reading the guidance above you can’t provide this information, please call us for advice on 01159249924 selecting extension 86838 and do not complete this form.

Name *

First

Last

Date of Birth *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

This is not mandatory but we recommend please providing this so we can locate and identify the correct information requested.

NHS Number or Hospital Number (If known)

(if known, should be on any letters from us)

Telephone Number

You do not have to provide this but it would be very helpful to avoid any unnecessary delays so we can call you if we have any queries or checks to undertake.

Email *

Confirm Email

What Hospital campus or site have you received care at? *

Queen’s Medical Centre (QMC)
Nottingham City Hospital (CITY)
Ropewalk House
Other (Please detail in the next section)

Please provide as much further specific information as possible in the following question to assist the Trust in being able to expedite and speedily locate this information for you. You don’t have to provide this but it will help the Trust find your information quicker.

What information do you require? *

Important Guidance (Please read)

Please provide as much detail as possible to prevent any delays in processing your request. If your enquiry is regarding CCTV, please advise of the location and time stamps. As well as either City or QMC Hospital.

To assist us with processing your request if there is specific information you would like please identify this.

Please note patient records may be held on a number of systems. Some of these are old systems for which the Trust do not have the ability to perform routine linked searches. Due to this we cannot 100% guarantee that we can locate all information we hold about you.

The Trust routinely discloses records from our main patient systems listed below. These have been used for many years and are nearly always sufficient to support any legal claims or for other legal purposes. However, if upon receipt of records you are concerned that records appear to be missing from an individual department or episode of care and you were expecting this, please do not hesitate to contact us and we will do our best to source and supply this. Please read the Trusts Supporting Information page for more information and FAQs.

Paper records where in existence
CareFlow Patient Administration System (PAS)
Emergency Department System (ED)
Picture Archiving Communications System (PACS)
Unity – Digital Health Record (DHR)
Nerve Centre (e-Observations) (if specified within the request)(ED)

What time period would you like us to search for and provide in relation to the data requested?

This will help us locate and expedite the request. For example do you just require the last 3, 6 or 12 months of your record or a recent assessment. The more specific you can be the Trust will be able to expedite this as much as possible. You don’t have to provide this but it will help the Trust find your information quicker. Give a date range of the information you are requesting, eg ‘From 1 April 2022 to 31 March 2023’. Give times if they’re relevant, eg 2-3pm for CCTV footage, or say what time the call started if you’re requesting a phone call transcript.

Would you like your information sending to a third party, another person or company? *

Please note for safety we ask this to be used for individuals requesting information being sent to solicitors. Please note at this time we are unable to facilitate this for friends or families, please select option 1 so the Trust can send this to you to forward on.

Please provide details of who & where to send your information.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Confirm Email

Solicitor / Third Party Reference

Please provide any reference that may make this easier for the third party to process. Please ensure the third part is aware of this request.

Please upload Proof of ID & Proof of Address

Click or drag files to this area to upload. You can upload up to 3 files.

Max of 3 files, no more than 5MB each. Photographs are accepted. It is essential to provide adequate proof of identification to permit us to establish your right of access to information under the Data Protection Act. If you can’t provide this information, please call us for advice on 01159249924 selecting extension 86838 and do not complete this form.

Signature *

Clear Signature

You can sign using your computer mouse or a touch screen device. By signing, you are confirming the above details are correct to your knowledge.

Accessing someone else's data

Is the individual deceased? *

As part of the Access to Health Records Act 1990 usually you will only be able to access the deceased person’s health or social care record if you’re either:

A personal representative (the executer of the administrator of the deceased person’s estate)
Someone who has a claim resulting from the death (this could be a relative or another person) Only information directly relevant to a claim will be disclosed.

You can find more information on accessing deceased persons records online here.

If possible, please ask the individual to compete this online form themselves from question 1 and they will be able to request us to send you the information directly.
If this is not possible you will need to provide evidence of:

A Lasting Power of Attorney for Health and Welfare for the individual OR
A Court Appointed Deputy for Personal Welfare for the individual
Parental Responsibility for a child under 18 years of age

What information are you requesting? *

What is the reason you require this information?

Your Name *

First

Last

Your Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Your Email *

Confirm Email

Your Relationship to Individual *

Your Ref / ID

This may be helpful if we need to contact you.

Upload Document Evidence *

Click or drag files to this area to upload. You can upload up to 3 files.

As mentioned above, please provide evidence of Lasting Power of Attorney (for Health & Welfare), Power of Attorney or any other documentation detailing your authorisation to have the requested data.

Signature *

Clear Signature

You can sign using your computer mouse or a touch screen device. By signing, you are confirming the above details are correct to your knowledge.

Data Subject (Individual)

Name *

First

Last

Date of Birth *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

NHS Number / NUH Reference Number

(if known, should be on any letters from us)

Are you applying in a personal capacity or as a third party (i.e Solictor)? *

Identification Evidence Required *

Click or drag files to this area to upload. You can upload up to 3 files.

Please ensure you provide Photographic ID from the data subject so we can confirm their identity as per guidance. If you can’t provide this information, please call us for advice on 01159249924 selecting extension 86838 and do not complete this form.

Public body request under Data Protection Act 2018 / Schedule 2 Part 1 Para. 2 or Para. 5 Data Protection Act 2018 (previously S29 Data Protection Act 1998) / Annex C Request

If you complete this online form it will trigger a digital approval process for efficiency – a copy will be sent via email to you and to your Authorising Officer. If this will not be possible please download our electronic form or send us yours for signature outside of this process.

The police and other public bodies can request access to personal information held by local authorities / public bodies for specified purposes. These types of request include Schedule 2 Part 1 Para. 2 or Para. 5 Data Protection Act 2018 and 2013 Protocol, Annex C information disclosure requests.

They can ask for information if it’s about:

prevention or detection of crime
the apprehension or prosecution of offenders
assessment or collection of tax, duty or imposition of a similar nature.

The Act:

does not give an automatic right of access to information
states that public bodies can assess the merits of requests and decide whether or not to apply the exemption

See the Information Commissioner’s Office guidance about exemptions. It includes reasons we must take into consideration when deciding whether to release information to relevant authorities.

Is this an urgent request? *

Yes, I need a response within 2 hours
No, a response within 48 hours will suffice

For an urgent response, please call the service in hours (9AM to 5PM Monday to Friday) on 01159249924 and select option 86838 before continuing with this form. Please be aware for Out of Hours Urgent responses please speak to the Senior Clinician / Estates (For CCTV) who will contact the Trusts Silver Command on Call if required or make the decision out of hours. Please do follow up and complete this form if information is provided on your next break.

Should you wish to continue completing this form, we will respond as soon as possible however it may be longer than 2 hours. Please exercise your judgment before completing this online form.

Requester / Your Details

Incident Number

Your Name *

First

Last

Job Title *

Organistion *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Telephone Number

Email *

Confirm Email

Data Subject (Individual) Details

Name of Individual *

First

Last

Date of Birth

Current or Last Known Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Without this additional information it will be difficult to search for any records. If you do not have this information please be aware it is unlikely we will be able to verified the data held against the data requested unless it is for CCTV.

Other identifying information e.g. previous address, other names the data subject is known by, NHS number etc.

What information do you require? *

If your enquiry is regarding CCTV, please advise of the location and time stamps. As well as either City or QMC Hospital.

Reason for requesting disclosure. Include what you intend to do with the information and how long you will retain it: *

Views of the Data Subject (Individual)

The presumption from the Trust in line with the National Police Chiefs’ Council (NPCC) in relation to Police Requests for Third Party Material and the joint briefing with Information Commissioner’s Office (ICO) is that the views of the data subject should be sought prior to submission of this formal request.

Please select the applicable option below (this will enable clinicians to make swift decisions on the release of the requested information and if it is necessary and proportionate): *

The views of the data subject have been discussed with the individual
The views have not been sought from the data subject because this would prejudice the investigation
The views have not been sought from the data subject because upon contact, did not wish to discuss
Views not sought as data subject could not be contacted despite reasonable attempts to do so
The data subject is deceased

Please describe the individual’s view of the request being made, including any objections *

Please explain why seeking the data subject’s views would prejudice the investigation *

Please outline what attempts have been made to contact the data subject *

In summary, based on the above information provided; please select an option below which best describes the situation: *

The disclosure (sharing) is necessary for the purposes of preventing or detecting an unlawful act;
Asking for the individual’s consent would prejudice those purposes
The disclosure is necessary for reasons of substantial public interest

Please state how non release of the information will prejudice your investigation *

Declaration and Authorisation

The authorising officer must be of the rank of police inspector or higher, or for other ‘relevant bodies’ a senior officer/manger. In the case of an inspector not being available at your location, we will accept an email from an inspector (or higher ranking officer) attaching this paperwork and confirming their approval.

Authorising Officers Name *

First

Last

If you are person authorising this information request, please enter your own details.

Authorising Officers Email *

Confirm Email

A copy of this completed form will be sent to the Authorising Officer for them to reply with authorisation of the request. This request will not be processed until the Authorising Officer has responded.

Declaration

I certify that:

Information requested is compatible with the stated purpose (section 4) and will not be used in anyway incompatible with that purpose
I understand information given on this form is correct
I understand that if any information given on this form is incorrect, I may be committing an offence under Section 170 Data Protection Act 2018

Signature *

Clear Signature

You can sign using your computer mouse or a touch screen device. By signing, you are confirming the above details are correct to your knowledge.

IMPORTANT: You will receive a copy of this form via email. A copy will also be sent to the Authorising Officer for approval. They will need to respond to the email before we can process the request.

Request public data under the Freedom of Information (FOI)

The Freedom of Information Act 2000 (FOIA) gives members of the public the right to request information that is held by public sector organisations such as NHS Trusts and local councils. You have the right to request information we hold under the FOIA.

The aim of the FOIA is to create a climate of openness in public services so that people can understand how operational decisions are made and how public funds are spent.

The FOIA does not permit the release of personal information such as health or employment records. If you require personal information held by the Trust, please select the first option on this page (Subject Access Request)

The FOIA covers all information held in a recorded format. The deadline to respond to requests made under the FOIA is 20 working days, although there are some circumstances where this may be extended under the terms of the legislation.

If the information you require is not available on our website via our Publication Scheme, please submit this form.

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Confirm Email

Please detail the FOI request below being as specific as possible: *

Please advise clearly what time frame/range of the information you are requesting. What time range do you wish to consider?should we to consider? *

This will help us expedite this request.

If you have a letter please upload below otherwise complete the above form instead:

Click or drag files to this area to upload. You can upload up to 2 files.