OMR2 - Medical Record Access form OMR2 - Medical Record Access form

OMR2 - Medical Record Access form

file-20190710-44453-1t59hje.jpgThe Health Record and Information Privacy Act 2002 (HRIP Act) creates the right of individuals to access their health information from NSW health service providers, public sector agencies and private sector organisations that hold health information​.

To request a copy of a patient medical record held at our clinic, please complete the Medical Record Access form (below).

Open Medical Record Access form


When completing the online form.

When using this form, the applicant is defined as the individual filling out the form, while the individual whose medical record is being requested is known as the patient.

Please note that an individual requesting a copy of their own medical record is recognised as both the applicant and the patient

  • Read and complete all sections, A through to G, and attach your proof of identity (Section C).
  • When applying for your own medical record, select the "I am requesting my own medical record" authority option (Section D).
  • When applying for another individual's medical record, indicate under what legal authority you are able to access the patient's medical record (Section D) and attach a copy of your supporting documents.

Who can request access?

An applicant can request access to their own health information, or to another individual’s health information if they present evidence of written consent from that individual.

An applicant can also request access to information about an individual who is incapable of making the request, as their authorised representative. An applicant may have parental responsibility or guardianship over children or other individuals for whom they hold power of attorney.

Our clinic must ensure that the applicant requesting access to health information has the right to do so. We may request proof of an applicant’s identity and, where relevant, evidence of parental authority, guardianship and power of attorney.

What fees are charged?

Under the HRIP Act, access should be provided without excessive expense. Fees can be charged to cover the cost of providing access to a medical record, such as administration, scanning and printing.

A $10.00 copy fee is payable for each record copy generated, either paper or digital. Each copy will be made available within seven (7) days of payment.

The copy fee will be waived under the following circumstances:

  1. The record access request is for a medical record transfer, by secure download or fax only, to a verified medical facility to ensure continuing patient care; or
  2. The record delivery request is for an in-person collection of a printed medical record copy from Green Square Dermatology by the applicant or the patient.

An additional $10.00 fee will be charged to post a printed copy of the medical record by registered post.

For record access other than medical record transfer or patient review, the applicant will be notified of any additional processing fees that may apply.

Timeframe to provide access.

The HRIP Act requires that a response to a request for access must be given within 45 calendar days. This response must either be the granting of access to the requested information or a refusal to grant this access; any other communication about the request is not a response under the terms of the Act. If a response is not given within 45 calendar days it will be treated as if the request has been refused.

All medical record access requests are, however, processed as quickly as possible.

Additional information.

Refer to our Medical record access statement for more information.

For assistance in completing this form, please contact our reception staff on (02) 92269600.