Subject Access Request Form

Under the Data Protection Act 2018 you have the right to request access to personal data that Douglas Macmillan Hospice holds about you. The form below is designed to assist you in the process of making a request for that information, we recommend you use it to ensure we have all the relevant information to speed the process up. However it is not mandatory and we will respond to requests made in other formats.

About You
I am the data subject (the person to whom the personal data relates to)I am not the data subject but have sufficient authority to request on their behalf (i.e. parent/guardian, legal guardian etc.)

If you are the data subject please upload proof of identity confirming your name and address e.g. passport, driving license, birth certificate or 2 official letters; if you are the data subject please provide documentation proving your relationship to the data subject or giving you written authority.

Details of the Data Subject (the person to whom the personal data relates to)
Title*

First name*

Last name*

Address 1*

Address 2*

Town*

Postcode*

Date of Birth*

Telephone Number

E-mail Address*

The data subject a patient/service user of Dougie Mac

The data subject is deceased

Your Details (if different from above)

Title

First name

Last name

Address 1

Address 2

Town

Postcode

Telephone Number

E-mail Address

The data subject is deceased

Details of Information Required:
Please put as much information as you can about the type of information you are requesting about the data subject: for example dates, systems, relationships with the organisation or specific documents. This will help us to identify the information you require.

Declaration:
The information I have supplied in this request is correct, I am the person whom the data relates to or am a representative on their behalf. I understand Douglas Macmillan Hospice may need to obtain further information in order to meet this request.

Date:

Contact

Subject Access Request

Subject Access Request Form