Authorization Release Form For Medical Records

Authorization Release Form For Medical Records Template for Singapore

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Key Requirements PROMPT example:

"I need an Authorization Release Form For Medical Records that allows my insurance company to access my full medical history from Singapore General Hospital, with the authorization valid for 6 months starting January 2025."

Document background

The Authorization Release Form For Medical Records is a crucial document in Singapore's healthcare system, designed to facilitate the legal and secure transfer of medical information. This document is required whenever a patient's medical records need to be shared with third parties, whether for continued medical care, insurance purposes, legal proceedings, or research. The form must comply with Singapore's Personal Data Protection Act (PDPA), Healthcare Services Act, and relevant medical practice guidelines. It includes specific details about the patient, the releasing healthcare provider, the recipient, the scope of information to be released, and the duration of authorization. This document serves as both a consent mechanism and a legal safeguard for all parties involved in the medical records transfer process.

Suggested Sections

1. Patient Information: Full identification details of the patient including NRIC/passport number, contact information, and date of birth

2. Healthcare Provider Details: Information about the releasing healthcare facility/provider, including name, address, and contact details

3. Recipient Information: Details of the person/entity authorized to receive the medical records, including name, relationship to patient, and contact information

4. Scope of Authorization: Specific medical information authorized for release, including types of records and date ranges

5. Duration of Authorization: Validity period of the authorization and expiration date

6. Consent Declaration: Express consent statement and acknowledgment of understanding of rights and implications

Optional Sections

1. Purpose of Disclosure: Specific reason for requesting medical records, used when required by receiving entity or for clarity of intent

2. Special Instructions: Any specific handling or delivery instructions, used when special arrangements are needed for record transfer

3. Cost Declaration: Information about associated fees and payment requirements, used when charges apply for record retrieval

Suggested Schedules

1. Identity Verification Documents: Copies of identification documents of patient and/or authorized representative

2. Power of Attorney: Legal documentation when someone other than patient is authorizing release

3. Specific Records Checklist: Detailed itemized list of specific records requested, when multiple record types are involved

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Insurance
Legal Services
Research Institutions

Relevant Teams

Medical Records
Legal
Compliance
Administration
Patient Services

Relevant Roles

Medical Records Officer
Healthcare Administrator
Compliance Officer
Medical Secretary
Privacy Officer

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Let's create your Authorization Release Form For Medical Records

Authors

Alex Denne

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