In the event that a patient who was treated at the University Hospital in Motol (hereinafter referred to as Motol University Hospital) or a person authorized by him or a person close to him (hereinafter referred to as the applicant) requests access to the medical documentation (hereinafter referred to as ZD) kept at Motol University Hospital , or if he requests an extract, transcript or copy of the medical documentation or part thereof, he must fill in the attached form "Protocol on access to medical records, or on obtaining extracts or copies".
The applicant shall state in this protocol the scope and form of the required information, the method of acceptance and the relationship with the patient. It is necessary to select the scope of inspection or the list of copies made from ZD.
Acquisition options are:
- complete ZD from the whole Motol University Hospital
- complete ZD from individual medical workplaces for a certain period
- autopsy report
- copies of images from imaging methods (X-ray, MRI, CT, etc.) taken on a CD
Send the completed form by post to:
University Hospital in Motol
Secretariat of the Deputy for Medical and Preventive Care
In Úval 84
150 06, Prague 5
Another option is to hand in the completed form in person at the relevant medical office or at the secretariat of the Deputy Medical and Preventive Care. The applicant may also send the form by e-mail to firstname.lastname@example.org. All such applications must include the elements listed in the table below.
If you have any questions, you can contact the secretariat of the Deputy for Preventive Medical Care, either in person or by phone at 224 431 011, 026.
If the patient has not identified the applicant in the "Informed Consent" as a person who can be informed of his / her state of health, or to look at the medical records kept about him / her or other records related to his / her state of health, obtain extracts or copies of these documents, the applicant is obliged to prove the relationship with the patient by submitting the relevant documents. See table below.
|Applicant||Conditions for providing information from the medical records of treated patients||Verification of the applicant 's identity|
|Patient in person||without consent||identity card|
|A relative of the patient||entry in the "Informed Consent" where the treated patient or legal representative agrees to provide information about the health status from the medical documentation
power of attorney with the written consent of the treated patient
|identity card, proof of family relationship, eg birth certificate, affidavit of a close person|
|A patient's relative after his death||entry in the "Informed Consent" where the treated patient or legal representative agrees to provide information about the health status from the medical documentation, no ban on the treated patient may be granted||identity card
proof of kinship by birth certificate or affidavit of a close person
For these services, the applicant is obliged to pay the costs associated with finding medical documentation and obtaining the requested statement or copy according to the current price list of Motol University Hospital not covered by health insurance and postage, if the documents are sent cash on delivery (according to the current price list of the Czech Post). Upon personal collection, payment is made in advance at the cash desk of the Motol University Hospital.
Extract from the price list of Motol University Hospital services not covered by health insurance, price incl. VAT:
|Administrative act||125 CZK for each started 10 min|
|Making a single-sided A4 copy||5 CZK|
|Making a double-sided A4 copy||7 CZK|
|Making a picture from the Clinic of Imaging Methods on CD||133 CZK|
To speed up the processing of your application please always provide telephone contact.
The Secretariat of the Deputy Minister for LPP or Medical Institutions will process the application within 30 days of receipt (according to Act No. 372/2011 Coll. Act on Health Services and Conditions for their Provision - Act on Health Services)