Documents and templates

[Name of institution]
[Address of institution]

[Full name], [date of birth]
[Unit / cell or postal address]

REQUEST TO PRESERVE CCTV FOOTAGE

[Date], [place]

On [date] at about [time], an incident took place at [location within the institution]: [brief description]. I believe that my rights (or the rights of [full name]) were violated during this incident.

I request that you:
1. immediately preserve all video and audio recordings from surveillance cameras and officers' body-worn cameras covering [location] on [date] from [time] to [time];
2. not overwrite or destroy these recordings while any investigation or complaint is pending;
3. confirm in writing that the recordings have been preserved.

These recordings are important evidence for establishing the circumstances of the incident.

[Signature]                [Full name]

[Name of institution]
[Health care unit]

[Full name], [date of birth]
[Unit / cell or postal address]

REQUEST FOR COPIES OF MEDICAL RECORDS

[Date], [place]

Under the Law of the Republic of Lithuania on the Rights of Patients and Compensation for Damage to Health, I request copies of the following documents:
1. records and conclusions of the medical examination carried out on [date];
2. the description and photographs of recorded injuries (if any were taken);
3. records of treatment, tests and referrals for the period from [date] to [date].

Please hand the copies to me in person (or send them to: [address]).

[Signature]                [Full name]

[To the head of the institution]
[Name and address of institution]

[Full name], [date of birth]
[Unit / cell or postal address]

COMPLAINT REGARDING [briefly: e.g. officers' conduct / poor conditions]

[Date], [place]

Facts:
[Facts in chronological order: who, when, where, who was involved, consequences.]

I believe the following rights were violated:
[E.g. the right to humane treatment, the right to health care.]

Evidence:
[Witnesses, documents, medical records, CCTV cameras.]

I request that you:
1. investigate the circumstances described;
2. take measures to remedy the violation: [what exactly you are asking for];
3. inform me of your decision in writing, including how it can be appealed.

Annexes:
1. [document]

[Signature]                [Full name]

Seimas Ombudspersons' Office of the Republic of Lithuania
Gedimino pr. 56, LT-01110 Vilnius
ombuds@lrski.lt

Applicant: [full name]
Postal address: [address]
Phone / email: [contact details]

COMPLAINT REGARDING THE ACTIONS OF [institution / officers]

[Date], [place]

1. What I am complaining about: [institution, officers if known].
2. Facts: [in chronological order, with dates].
3. Rights I believe were violated: [...].
4. Other institutions contacted and replies received: [...] (copies attached).
5. Has a court been asked to decide the same matter: [yes / no].

I ask you to investigate this complaint and [state what you seek].

I consent to my personal data being processed for the purpose of investigating this complaint.

Annexes:
1. [document]

[Signature]                [Full name]