Request Form for Obtaining Personal Information

This is the recommended form for requesting personal information from the registries of the central database of the electronic healthcare system.

The request is submitted by the Requester – the patient (or their legal representative) to the NHSU by sending a letter using one of the following methods (at your discretion):

• By postal mail to the NHSU address: 04073, Kyiv, Stepan Bandera Avenue, 19, in paper form. The request can be completed electronically, printed, and signed with the personal signature of the Requester – the patient (or their legal representative).
• By email to NHSU at [email protected] as a single file in DOC, DOCX, or PDF format, with the Requester’s qualified electronic signature (QES) – the patient (or their legal representative).

Please note that if you have questions regarding submitting the request or its attachments (for example, if the request is submitted by a legal representative of the patient or an authorized person), it is recommended to contact the NHSU Contact Center at 1677.