en
Subject Access Request Form
ga
Foirm um iarratas Duine ar a shonraí
This sample shows 10 sentences.
Subject Access Request Form
Foirm um iarratas Duine ar a shonraí
Under the General Data Protection Regulation ( GDPR ) it is your right to request a copy of any personal data that we hold on you .
Please note that this form is to aid with the Subject Access Request process but we will accept your request made in writing .
Faoin Rialachán Ginearálta maidir le Cosaint Sonraí ( RGCS ) tá sé de cheart agat cóip d ' aon sonar pearsanta atá again fút a fháil .
Tabhair faoi deara gur chun cabhrú leis an bpróiseas um iarratas Duine ar a shonraí a cuireadh an fhoirm seo ar fáil ach glacfar le d ' iarratas i scríbhínn freisin .
If you want to submit a request , send the completed form or letter to your local hospital or service provider where you think your records are held .
Má theastaíonn uait iarratas a chur isteach , seol an fhoirm comhlánaithe nó litir chuig d ' ospidéal áitiúil nó soláthróír seirbhíse pé áit a mheasann tú go bhfuil do chuid sonraí coinnithe .
Further information on the Subject Access Request process can be found on the SAR information leaflet or at https : / / www.hse.ie / eng / gdpr / full Name date of Birth any Previous Names
Tá tuilleadh eolais faoin bpróiseas iarratas Duine a shonraí atá le fáil ar bhileog eolais iarratas Duine ar a shonraí nó ag https : / / www.hse.ie / eng / gdpr / ainm iomlán dáta breithe aon ainm Eile roimhe Seo
Hospital Chart No .
( If applicable ) current address
Uimh .
Chairte ospidéil ( más bainteach ) seoladh reatha
Previous addresses ( if applicable )
Seoltaí roimhe Seo ( más bainteach )
Primary phone number | Other phone number email address
Príomh Uimhir Fóin | Uimhir Fóin Eile seoladh ríomhphoist
Please describe the information you are looking for , including dates and locations of services involved .
Déan cur síos ar an fhaisnéis atá uait , mar aon leis na dátaí agus na suíomhanna ar fad ina bhfuil na seirbhísí atá faoi chaibidil .
· please tick to confirm you have attached of copy of a photo ID ( Passport , Driving Licence , Public Service Card etc . ) signature date for Employee Use Only
· Ticeáil chun a dhearbhú go bhfuil cóip iniata ded ' Aitheantas Fótagrafach ( pas , ceadúnas Tiomána , cárta Seirbhísí Poiblí 7rl . ) síniú dáta d ' fhostaithe amháin
Received By : name date immediately give this form to your local data protection decision maker
An té a fuarthas : ainm dáta Tabhair an fhoirm seo láithreach don cinnteoir cosanta sonraí áitiúil .