Request for access to medical records (Poland)

Medical
Application
Poland
Polski
Print & sign
1 page · 0 sold

Published byDocMuse

This document is in Polish

The PDF you download is in Polish — that is the language it has to be filed in, so it is not translated. Everything on this page is here to tell you what it says.

A request to a Polish hospital, clinic or practice for a patient's medical records: the patient's details and PESEL, what records and which treatment period, who is asking — the patient, a legal representative, an authorised person or a close relative of a deceased patient — and the form to underline: inspection, a paper or electronic copy, an extract or a transcript. It reminds the provider that the first copy in the requested scope is free for the patient (Patient Rights Act).

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Common questions

Do copies of medical records cost anything in Poland?
The first copy in the requested scope and form is free for the patient and their legal representative (art. 28 of the Patient Rights Act). For further copies, transcripts and extracts the provider may charge per page, but no more than the statutory cap linked to the average wage. Inspecting the records on the premises is always free, and many documents are also available in the online Patient Account (IKP).
Who can obtain the medical records of a deceased patient in Poland?
A close person — a spouse, a relative to the second degree, an in-law of the first degree, a legal representative, a partner living with the patient, or someone the patient named — unless the patient objected while alive (art. 26(2) of the Patient Rights Act). People the patient authorised during life also have access. It helps to attach proof of the relationship, such as a civil-status certificate.
In what form does a Polish medical provider give access to records?
For inspection on the premises, as a copy, transcript or extract, electronically on a data carrier or by electronic means, and the original only against a receipt and for return, when a court asks for it for example (art. 27 of the Patient Rights Act). The provider must give access without undue delay and give reasons for any refusal. The patient can also authorise someone else to collect the records.

How you can sign this document

  • Print it and sign by hand. The signature lines in the document are left blank on purpose — sign on them in ink.
  • Sign it yourself with a qualified electronic signature. If you already hold a QES — Evrotrust, B-Trust, StampIT, ZealiD or any qualified provider on the EU Trusted List, on a card, a USB token, in a mobile app or in the cloud — our signing guide explains step by step how to sign this exact file without invalidating it. Step-by-step help, and a way to check it worked

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