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SECTION 7: Authorisation
I wish the Ombudsman to investigate my complaint and I consent to the obtaining
of all relevant papers including medical records, for the purposes of investigating a
complaint under the Health Service Commissioners Act 1993.
Signature: ______________________________________________________________
Date: __________________________________________________________________
If you are complaining on behalf of someone else, they must sign here if they
are able to. If they are not able to, please explain why.
I give my consent for a complaint to be made on my behalf and for the
Ombudsman to obtain all relevant papers, including medical records, for the
purposes of investigating a complaint under the Health Service Commissioners Act
1993. I understand that this may mean that my representative will be able to
access personal information obtained for the investigation.
Signature: ______________________________________________________________
Date: __________________________________________________________________
Parliamentary and Health Service Ombudsman
Millbank Tower
Millbank
London SW1P 4QP
Enquiries: 0345 015 4033
Fax: 0300 061 4000
Email: phso.enquiries@ombudsman.org.uk
www.ombudsman.org.uk