{YOUR NAME}

{YOUR ADDRESS}

{Name of GP Practice}

{Practice Address}

{Today's date}

Dear {INSERT GP'S NAME}

My child/children is/are currently registered at your practice: 

{CHILD’S NAME}  -  {CHILD’S DATE OF BIRTH}

{CHILD’S NAME}  -  {CHILD’S DATE OF BIRTH}

{CHILD’S NAME}  -  {CHILD’S DATE OF BIRTH}

She/He/They stay with their mother/father at {INSERT MOTHER/FATHER RESIDENTIAL ADDRESS}.

I request that you please notify me of any important medical information relating to my child. 

I understand that you have recently seen my child and I would like to understand more about the outcomes of that consultation.  I would appreciate you contacting me to discuss either via telephone or in writing, using the contact details I have provided.

Choose only 1 of the following sentences to include in your letter...

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I understand and acknowledge that you may require proof of Shared Parental Responsibility, and have therefore enclosed proof for your records. 

(ENCLOSE THE FAMILY COURT DOCUMENTATION THAT DETAILS YOU HAVE SHARED “PARENTAL RESPONSIBILITY”)

OR

It has been determined that I have sole parental responsibility for my child/children.  As such, I would appreciate you contacting me directly should there be any request for access to my child’s medical records from any third party, including their other parent.  I understand and acknowledge that you may require proof of Parental Responsibility, and have therefore enclosed proof of Sole Parental Responsibility for your records. 

(ENCLOSE THE FAMILY COURT DOCUMENTATION THAT DETAILS YOU HAVE SOLE “PARENTAL RESPONSIBILITY”)

OR

We have not yet formalised the issue of parental responsibility and at this stage we continue on the shared parental responsibility we exercised whilst we resided together.  No Court Order has been issued restricting either parent’s right to parental responsibility. This you can confirm by contacting {ENTER THE NAME OF THE OTHER PARENT} on {INSERT OTHER PARENT’S PHONE NUMBER}.    

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I am making this request in the interests of the wellbeing of my child. You are no doubt familiar with the Australian Medical Association’s Guidelines for Doctors on Disclosing Medical Records to Third Parties (2010), which outline the provision of records to both parents regardless of marital status. 

I understand that there may be an additional cost associated with providing the records and would appreciate you detailing to me, what this is likely to be.

Please ensure that my contact details are placed on my child’s medical records and that I am contacted in the event of anything prominent, such as allergies, serious conditions, injury and emergencies, etc.. or any request for access to the records.

Thank you in advance for your cooperation. Please do not hesitate to contact me, should you require further assistance.

Yours sincerely,

{YOUR NAME}

Email: {YOUR EMAIL ADDRESS}

Phone: {YOUR TELEPHONE CONTACT DETAILS}