Step 2: Certification Details

Step 3: Surgery Details & Consent

Enter part or all of the practice name to find your GP surgery

Informed consent to obtain health records

Background:

Medidata Exchange Limited, trading as Medi2cert (Medi2cert, We, Us), is requesting a copy of your GP Subject Access Request for the purpose of producing a firearms medical certificate. The medical information will be clinically reviewed by our partner GP provider, Tekihealth Solutions Ltd, working on Medi2cert’s behalf. Your GP practice and Police constabulary/Firearms department will be provided access to the completed firearms medical certificate.

Why do we ask for this form?

This form gives us access to more information about your health and medical history. To create your firearms medical certificate, Medi2cert needs to obtain your full medical history in the form of a Subject Access Request. This information will be reviewed by GMC registered GPs and will be treated in accordance with all data privacy requirements. Information regarding your health is considered to be Special Category Data – this is personal data that needs more protection because it is sensitive. We will only process Special Category Data for you with your explicit consent as set out in this form. Such personal data received by Medi2cert is protected under the Data Protection Act 2018 (UK) and the General Data Protection Regulation (EU) 2016/679 (GDPR) (jointly, the Data Protection Laws), and will be retained confidentially and not be disclosed without your express written authority to any third party other than Medidata Exchange Limited and Tekihealth Solutions Ltd, as listed above. For any queries relating to data protection or to exercise any of your data subject rights, you can contact Medi2cert’s data protection team via email at dpo@medi2data.com.

Your health records

Your health records typically contain information from almost all consultations and contacts you have had with health professionals in the practice and information sent to the practice about you from others, such as hospital letters.

The information they contain usually includes:

why you saw a health professional;

• Details of clinical findings and diagnoses, investigations, tests and scans;
• Any options or recommendations for care and treatment the health professional discussed with you;
• The decisions made about your care and treatment, including evidence that you agreed; and
• Details of actions health professionals have taken and the outcomes.

Declaration and Consent:

By signing this form, I confirm that:

• The information provided above is correct to the best of my knowledge.
• I consent to Medidata Exchange Limited, trading as Medi2cert, requesting my medical information from my registered GP practice for the purposes of producing a firearms medical certificate.
• I consent to the disclosure of my personal information to Medidata Exchange Limited and Tekihealth Solutions Ltd.
• I consent to Tekihealth Solutions Ltd having access to my Subject to Access Request, for the purpose of conducting a clinical review resulting in the production of a firearms medical certificate.
• Medidata Exchange Limited will use this form as proof that I have given my consent to obtain my medical information.
• I consent to the completed firearms medical certificate being shared with both my GP practice and the Police constabulary/Firearms department, in addition to receiving a copy myself.
• I have read the enclosed statement notifying me of my rights. I understand that any information obtained will be used by Medidata Exchange Limited as set out in this form and as further detailed in Medidata Exchange Limited’s privacy policy (which can be located on their website - https://www.medi2data.com/).

Step 4: Overview & Confirmation

Step 5: Payment & Order Confirmation