Northpoint Subject Access Request (SAR)

Subject Access Request (SAR)

Or other information request about a service user
Ask us here for a copy of information relating to you (or someone else, on their behalf).

Please note:

1. If your request is in relation to the following services (even if you saw a Northpoint practitioner), you should contact the relevant organisation and follow their subject access request process, as we are not the data controller and so will not be able to help you at Northpoint:
- Leeds Mental Wellbeing Service (LMWS) - contact Leeds Community Healthcare
- Healthy Minds or the Mental Health and Wellbeing Advisors, referred by your GP practice - contact your GP practice
2. If you're looking for a letter of support or similar, this is not a subject access request and you should not complete this form.

Please contact your therapist/practitioner direct, or email/call Northpoint for assistance - giving as much information as you can about your details, your Northpoint practitioner/service, and what you need from us, so we can direct your request as efficiently as possible:

info@northpoint.org.uk
0113 245 0303

3. If you're a professional from outside Northpoint, you will need to upload evidence of consent from the data subject with this form, or evidence of authority to act on their behalf, so please have an electronic version of this proof ready.

__________________

Otherwise, please complete this form, being as specific and detailed as you can, to help us help you.

You'll receive an immediate auto-response email, which will give you a copy of your information request, and the information below about what to expect next.

We'll respond to your request within one calendar month of receiving confirmation of your ID if required, and any other information we may need to process the request.

Your details

i.e. details of the requester (whether data subject, parent/carer or professional)
Please put your own name and email address here, even if you're completing the form on behalf of someone else - including if you're a Northpoint member of staff.
Your name*
First & last name
Your email address*
For our response, and for a copy of this request
Are you contacting us in a professional capacity (including Northpoint staff), requesting information about or on behalf of a client or carer?*

YesNo
Do you work for Northpoint?*

YesNo
Your role/job title*
Your service/team*
Name of requester (on whose behalf you're completing this form)*
First & last name
Hidden 'pp' marker for submissions made by Northpoint staff on behalf of requester
When was this request first received by Northpoint? - either verbally or in writing, and whether via practitioner, manager or other staff*

DayMonthYear
How was this request received?*
Which mailbox was the request sent to?*
Which location was the request sent to?*
Give OTHER mailbox/location, or any other relevant details about how/when the request was received (but not the content of it - see below) - otherwise 'n/a'*
Please forward the original email to riskandcompliance@northpoint.org.uk, as well as submitting this form.
Please scan the letter to riskandcompliance@northpoint.org.uk, as well as submitting this form.
[HIDDEN: was general question re how/when the request was received - OLD - no longer used]
If you haven't got all the information requested on this form, please just fill it in as best you can from the information you have (e.g. put 'not known', 'not stated', etc) - the Risk & Compliance team will follow up as required.

And your job is then done - thank you.
Your role*
Your organisation or company*
Your phone number*
Are you requesting information about yourself?*

YesNo

Data subject name

i.e the name of the person whose information you're requesting
Name*
First & last name
Today [HIDDEN for age calculation]

YearMonthDay
(YYYY-MM-DD)
Age of data subject (calculated)
Data subject details

i.e. your details, to help us identify any information we hold about you
Are you under 18?*

YesNo
Are you over 12?*

YesNo
We may need to contact your parent/carer to confirm your request.
Your date of birth [OLD FIELD - no longer used]
DD/MM/YYYY
Your date of birth*

DayMonthYear
Your DoB [HIDDEN for age calculation]

YearMonthDay
(YYYY-MM-DD)
Your postcode*
Your school*
Your GP practice (if applicable)
If you've been seen through your GP by our Healthy Minds Practitioners or Mental Health and Wellbeing Advisors
Data subject details

i.e. details of the person whose information you're asking for, to help us identify any information we hold about them
Is this person:*

An adultA child or young person (i.e. under 18)
Your relationship to them*
Relationship of requester to the data subject (or their professional role and service/company)*
Date of birth [OLD FIELD - no longer used]
DD/MM/YYYY
Date of birth*

DayMonthYear
DD/MM/YYYY
DS DoB [HIDDEN for age calculation]

YearMonthDay
(YYYY-MM-DD)
Postcode*
School*
GP practice (if applicable)
If they've been seen through their GP by our Healthy Minds Practitioners or Mental Health and Wellbeing Advisors

Child or young person consent

(for parent/carer requesters)
If you are requesting information relating to a child in your care, please note that this data belongs to the child or young person, whatever their age or capacity. This means that, if they are deemed by our professionals to be Gillick-competent*:
- They should be aware of this information request
- We will need their consent to share, before we can proceed
- We will need to show them the data that we're proposing to share with you, before we do so
And we will therefore need to contact them directly. If you can help us by providing their contact details in advance, as requested below, this can really speed up the process.

If the child or young person is not deemed to be Gillick-competent (for example, if they're too young), we won't need to contact them directly.

*Gillick competency is the capacity of a young person to make their own choices and decisions about their health and wellbeing, including about whether to share their information (such as that gathered in assessment or counselling) - even with their own parents/carers.
Is your child aware of this information request?*

YesNoNot sure
Please explain why, if not or if you're not sure*
Child or young person's mobile number*
Child or young person's email address
(This is helpful if possible)

Data subject consent

(for professional requesters)
Please upload appropriate evidence of written consent from the data subject.*

Cancelof

Service details

Please give us any details you can, to help us locate the information you require
Which Northpoint service/s does your subject access request relate to? (tick any that apply)*

Calderdale Mental Health Support Team (MHST)Calderdale Open Minds (CAMHS)Children's Centre Counselling ServiceDistrict 29 Therapeutic CommunityGP-based services (Healthy Minds Practitioners / Mental Health and Wellbeing Advisors)Leeds Mental Wellbeing Service (LMWS)Mondays @ NorthpointSchool Therapy ServicesNot sure? - please add anything more you can below, about the type or location of service used
Please do not submit this form, as we are not the data controller and so will not be able to help you at Northpoint. Instead, you'll need to contact the relevant organisation and follow their subject access request process:
- Leeds Mental Wellbeing Service (LMWS) - contact Leeds Community Healthcare
- Healthy Minds or the Mental Health and Wellbeing Advisors - contact your GP practice
Location/type of contact (e.g. Calderdale, Leeds, in school, at GP practice, phone/video call, face to face - any of these details would help us locate the information you require)*
Name/s of any Northpoint therapist-practitioner/s or other staff involved (as far as you know - to help speed up the process)*
First & last name (if possible)
Approx dates of involvement with Northpoint services (as far as you know):
From*
Month and year, if possible
To*
Month and year, if possible

Your requested information
What kind of information are you seeking from us? (tick any that apply)*

LETTER OF CONFIRMATION of sessions and datesCLOSING SUMMARY/DISCHARGE LETTEROTHER - please specify below
Please give any further detail you can about what information you need from us
Other notes
Anything else you think we should know
Thank you

You'll receive an auto-response email, which will give you a copy of your subject access request submission, and more information about what to expect next.
Should be Empty:

Subject Access Request (SAR)

Your details

Data subject name

Data subject details

Data subject details

Child or young person consent

Data subject consent

Service details

Your requested information

Other notes