I, the undersigned, wish to make a complaint on behalf of…………………………………………………………. I acknowledge that in order to investigate this complaint, it will be necessary for you to approach the staff who were involved in their care. I understand that it will also be necessary to access their NHS Health Records and any relevant records held at [University Hospitals Bristol NHS Foundation Trust][North Bristol Trust][other organisation]. I hereby give my written confirmation that, as the patients Next of Kin, I have all due rights and authorisation required to access the deceased patient’s details, which may be of a confidential and sensitive nature. Signed Print Name Date
I, the undersigned, wish to make a complaint on behalf of…………………………………………………………. I acknowledge that in order to investigate this complaint, it will be necessary for you to approach the staff who were involved in their care. I understand that it will also be necessary to access their NHS Health Records and any relevant records held at [University Hospitals Bristol NHS Foundation Trust][North Bristol Trust][other organisation]. I hereby give my written confirmation that, as the patients Next of Kin, I have all due rights and authorisation required to access the deceased patient’s details, which may be of a confidential and sensitive nature. Signed Print Name Date
consent_form_-_june_2017__1_.docx