[Enter name and address of employee]
[Enter date]
Private and confidential
Dear [insert name of employee],
Consent for pre-employment medical examination and report and access to medical records
As outlined in your offer letter dated [insert date], our offer of employment is conditional on satisfactory evidence of your fitness to carry out the duties of the role offered. We therefore write to obtain your consent to us obtaining a written report from [an independent medical practitioner OR our Company doctor] and to that doctor being given access to your medical records so that he or she can review your medical history as part of his or her examination.
Upon receipt of the report, we will discuss any matters arising with you and will consider making reasonable adjustments in accordance with our obligations under the Equality Act 2010.
Since producing the report will involve processing your personal sensitive data, your consent will be required according to the Data Protection Act 1998 and the Access to Medical Reports Act 1988.
Please complete and return the enclosed consent form using the envelope provided.
Yours sincerely,
[insert name of employer’s representative]
Encl: consent form, Access to Medical Reports Act information
Date:
[insert date]
Employee name:
[insert name]
Employee date of birth
[insert date of birth]
Employee address:
[insert address]
Employer name:
[insert name]
Private and confidential
To: [insert name of doctor]
I confirm that:
• I am a patient of yours
• I understand that my employer wishes to obtain a medical report from you in order to assess my fitness to perform the duties of the role they have offered me, whether I am disabled for the purposes of the Equality Act 2010 and whether there are any reasonable adjustments which they should consider making to help me.
• I [do not]* consent to you producing a [written/oral]* report for my employer on my medical condition
• I [do not]* agree to undergo examination by you to enable you produce such a report with the benefit of up-to-date information on my medical condition
• I [do not]* agree to you discussing your findings with my employer after producing your report
• I [do not]* consent to the processing [by you/my employer]* of my sensitive personal data required in order to carry out the above
• I have read and understood a summary of my rights under the Access to Medical Reports Act 1988
• I [do not]* wish to see a copy of the medical report before it is supplied to my employer
• I am willing to pay your reasonable fee for sending me a copy of the report/I will contact you within 21 days of my employer’s request to make an appointment to view the report*
* employee to delete as applicable
Signed: _____________________
Name of employee:
Date:
As an employee, you have certain rights under the Access to Medical Reports Act 1988:
• You are entitled to have access to any medical report obtained about you for employment or insurance purposes
• You are entitled to be notified that we propose to apply for a medical report concerning you and that we require your consent to do so
• You are entitled to withhold or give your consent to that proposal
• Where you give your consent, you are entitled to state that you wish to have access to the report before it is sent to us
• You are entitled to change your mind about withholding or giving consent
• You are entitled to change your mind about having or not having access to the report before it is sent to us (as long as you tell us you have changed your mind before the report is actually sent to us), subject to the timescales identified below
• Where you request access to the report before it is sent to us, you are entitled to have the doctor notified of this requirement by us and for us to let you know when we have made the application for the report
• Where you do request access to the report, this means it will either be made available for you to inspect or you will be sent a copy (for which the doctor may charge a reasonable fee to cover his/her costs). Even if you initially decide not to request access to the report before it is sent to us, you can still ask the doctor for access to it up to six months after he/she has sent it to us
• Where you do require access to the report before it is sent to us, you must contact the doctor within 21 days of when we apply for the medical report to arrange to see it, otherwise if the doctor hasn’t heard from you within 21 days, the doctor can send it to us without having to contact you or give you access to it first
• If you change your mind because you now want to see the report you should contact your doctor and make arrangements to see the report within 21 days of contacting your doctor; if your doctor does not then hear from you within 21 days about those arrangements, your doctor can send it to us without having to contact you or give you access to it first
• Where you have asked to see the report before it is sent to us, it will only be supplied to us if you tell your doctor that you agree to it being sent to us. You do not have to give that consent
• Where you are given access to the report, and you think that all or part of it is incorrect or misleading, you can ask to the doctor in writing for the report to be amended before it is supplied to us (although he/she is not obliged to do so)
• Where you ask for the report to be amended but the doctor does not do so, you can either agree to the report being sent to us unaltered; or ask the doctor to attach a statement setting out your views to the report; or withdraw your consent for the report to be supplied
• The doctor does not have to give you access to any part of the report that he/she considers:
◦ might cause serious harm to your physical or mental health, or that of others, or
◦ might indicate his/her intentions towards you, or
◦ would reveal information about a third party or the identity of a third party who has given the doctor information about your health, unless that person consents or is a health professional involved in your clinical care
• Where the doctor chooses not to give you access to part of the report in any of these circumstances, he/she will notify you of this in writing and will allow you to see the remaining parts
• Where the doctor considers that the circumstances apply to the whole report, he/she will not give you access to it but will not send it to us either, unless you consent to him doing so