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). In order to do this please answer the following questions carefully and supporting documentation.

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 you can’t provide this information, please call us for advice on 0300 330 2940 and do not complete this form.

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.

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 Wellbeing for the individual
- Power of Attorney

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 for signature outside of this process.

The police and other public bodies can request access to personal information held by local authorities 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 Commissioners Office guidance about exemptions. It includes reasons we must take into consideration when deciding whether to release information to relevant authorities.

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

Most partners within NEL have a formal information sharing charter which enables the sharing of health and social care information for specific purposes. Please complete this short form below to help us quickly identify the data and respond efficiently.