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Sarsform PDF

Under the GDPR, individuals have the right to request a copy of any personal data an organization holds on them. This Subject Access Request form can be used to initiate that process, but a written request will also be accepted. The completed form or letter should be sent to the local hospital or service provider where the requester thinks their records are held. Further information on Subject Access Requests and how to submit one can be found in the SAR information leaflet or on the HSE website.

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40 views1 page

Sarsform PDF

Under the GDPR, individuals have the right to request a copy of any personal data an organization holds on them. This Subject Access Request form can be used to initiate that process, but a written request will also be accepted. The completed form or letter should be sent to the local hospital or service provider where the requester thinks their records are held. Further information on Subject Access Requests and how to submit one can be found in the SAR information leaflet or on the HSE website.

Uploaded by

ella003
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Subject Access Request Form

Under the General Data Protection Regulation (GDPR) it is your right to request a copy of any personal data
that we hold on you. Please note that this form is to aid with the Subject Access Request process but we will
accept your request made in writing. If you want to submit a request, send the completed form or letter to your
local hospital or service provider where you think your records are held. Further information on the Subject
Access Request process can be found on the SAR information leaflet or at https://www.hse.ie/eng/gdpr/

Full Name Date of Birth

Any Previous Names Hospital Chart No. (if applicable)

Current Address

Previous Addresses (if applicable)

Primary phone number | Other phone number Email address

Please describe the information you are looking for, including dates and locations of services involved.

 Please tick to confirm you have attached of copy of a photo ID (Passport, Driving Licence, Public Service Card etc.)

Signature Date

For Employee Use Only


Received By:

Name Date
Immediately give this form to your local data protection decision maker

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