Template for a letter from an employer to ask for a worker's permission to approach their doctor for health information. Free to use.
You must get permission from the worker before contacting their doctor.
Find out more about getting a doctor's report about a worker's health
You can copy and paste the template text into an email or document.
Template
To: [worker's name]
[Worker's address]
From: [your name]
[Name of your organisation]
[Address of your organisation]
[Today's date]
Dear [worker's name]
We want to get a medical report from your doctor to [manage sick pay / plan work / support you].
We would like information about:
[List the things you're asking about. For example:
- their absence from work, including absence dates
- their health condition, such as a broken wrist]
Under the access to Medical Records Act 1988 you have the right to:
- refuse us permission to get a medical report
- ask to see the doctor's report before it is sent to us
- ask the doctor to correct the report if it contains anything inaccurate or misleading
- refuse to allow the report to be shared with us
- change your mind about not seeing the report before it is sent to us – provided you tell your doctor within 21 days of us applying for the report
- ask to see a copy of the report at any time within 6 months of it being completed
If you want to see the report before it is sent to us, you must contact your doctor within 21 days of us applying for the report to arrange to see it. If you do not contact the doctor within 21 days, they can send the report directly to us.
You may need to pay a fee to your doctor to see a copy of the report.
The report will only be shared with [add names]. We confirm that we will store the report securely in line with the General Data Protection Regulation (GDPR).
Please sign and return the attached consent form.
Yours sincerely,
[Your name]
[Your telephone number]
[Your email address]
Download this template
- Download this template in Microsoft Word format (DOCX, 18KB)
- Download this template in Open Document format (ODT, 9KB)
If you need the template in a different format, email digital@acas.org.uk