Example Of A Filled Gp69 Form Jun 2026

REPUBLIC OF KENYA PERSONAL HISTORY AND SERVICE RECORD (GP 69)

Here is an example of a completed GP69 form:

The GP69 form plays a significant role in maintaining patient confidentiality while also allowing patients to share their medical records with third parties when necessary. The form ensures that patients are in control of their medical records and can provide informed consent for disclosure. example of a filled gp69 form

| | Details Entered | | :--- | :--- | | Surname | NJOROGE | | Other Names | JOHN KAMAU | | Date of Birth | 12th April 1985 | | Place of Birth | KIAMBU COUNTY | | Nationality | KENYAN | | ID Number | 30215478 | | KRA PIN | A012345678X | | Marital Status | MARRIED | | County of Origin | KIAMBU | | Sub-County | RUIRU | | Home Address | P.O. Box 123, Ruiru | | Mobile Number | +254 722 123456 | | Personal Email | john.kamau@gmail.com |

Below is a detailed guide and a simulated example of how this form is correctly completed. REPUBLIC OF KENYA PERSONAL HISTORY AND SERVICE RECORD

"I hereby certify that I have this day examined the above-named candidate and that in my opinion she is fit for permanent service." Station: Nairobi Date: 10th May 2026

This section captures the officer’s identity. Box 123, Ruiru | | Mobile Number |

The GP69 form, also known as the "Request for disclosure of medical records" form, is a standardized document used by GPs in the UK to obtain consent from patients to disclose their medical records to a third party. The form requires patients to provide details of the third party they want their records to be disclosed to, as well as the specific records they wish to be shared.

The GP69 Form is more than just paperwork; it is the "service passport" for a government employee. A correctly filled GP69 form ensures that an officer’s service record is unbroken and verifiable, guaranteeing a smooth transition into retirement and ensuring all benefits are paid correctly and on time.