CLINICAL DOCUMENTATION REQUEST FORM
From the date of submitting this document, and after 5 (working) days for proof copies and 10 (working) days for copies of complete histories, you can come and collect the requested documentation at the main reception desk. To collect the documents, you will need to present this application form together with your ID card and, if applicable, the documents listed in the PROOF OF ID section. An advance payment of €5 per CD and €7 per imaging film will be required. If the copy is not collected within two months of the application, it will be destroyed.
Proof of ID required for clinical documentation management
- IF YOU ARE THE PATIENT REQUESTING THE DOCUMENTATION
When you come to collect your documents, you must prove your identity with the original of your ID card or passport and the duly completed Clinical Documentation Request Form.
- IF YOU HAVE BEEN AUTHORISED BY THE PATIENT
Complete the authorisation on the same form or complete a letter of authorisation or representation signed by the patient, including the full name of the authorised person (a photocopy should be included with the application). Also enclose a copy of the patient’s ID card or passport and a copy of the identity card or passport of the authorised person.
When you come to collect your documents, you must present the original of the patient’s ID card or passport and the original of the authorised person’s ID card or passport.
- IF YOU ARE THE PARENT, IN THE CASE OF CHILDREN UNDER 16 YEARS OF AGE
Attach a copy of the applicant’s ID card or passport and family register (Libro de Familia) to the application.
When you come to collect your documents, you will need to present the original of the applicant’s ID card or passport (a photocopy must be attached to the application) as well as the family register (a photocopy must be attached to the application).
- IF YOU ARE THE PATIENT’S LEGAL GUARDIAN
Attach a copy of the document confirming the judicial appointment of legal guardianship to the application. The guardian’s original ID card or passport and original ID card or passport of the patient.
To collect the documents, you will need a document confirming the judicial appointment of legal guardianship. The guardian’s original ID card or passport and original ID card or passport of the patient
- DECEASED
Attach copy of the ID card or passport of the deceased and a copy of the ID card or passport of the applicant to the application. A copy of a document certifying the direct family relationship or that of a legitimate third party. If the death did not occur at the Clinic, the death certificate must be provided.
* This is all in compliance with Law 41/2002, of 14 November, the basic law regulating patient autonomy and rights and obligations regarding clinical information and documentation. And REGULATION (EU) 2016/679 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data and repealing Directive 95/46/EC (General Data Protection Regulation) and Organic Law 3/2018, of 5 December, on the Protection of Personal Data and the Guarantee of Digital Rights.
