Release Of Health Information Form

Release Of Health Information Form Template for Switzerland

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Key Requirements PROMPT example:

"I need a Release of Health Information Form for a Swiss private clinic in Zurich, allowing the transfer of my complete medical history to a new healthcare provider in Geneva, with the authorization valid from March 1, 2025, to September 1, 2025."

Document background

The Release of Health Information Form is a crucial document in the Swiss healthcare system, required whenever protected health information needs to be shared between different healthcare providers, institutions, or authorized parties. This document is essential for maintaining patient privacy rights while facilitating necessary information sharing in accordance with Swiss federal laws, including the Federal Act on Data Protection and the Federal Act on Electronic Patient Records. The form must be used when transferring medical records between providers, sharing information with insurance companies, or releasing data for research purposes. It contains specific provisions for patient identification, detailed description of information to be released, purpose of disclosure, and duration of authorization. The document ensures compliance with Swiss medical confidentiality requirements and data protection standards, including specific cantonal regulations where applicable.

Suggested Sections

1. Patient Information: Full legal name, date of birth, address, contact information, and any relevant patient ID numbers

2. Healthcare Provider Information: Details of the healthcare provider/facility currently holding the medical records, including name, address, and contact information

3. Recipient Information: Details of the person or entity to whom the medical information will be released, including name, address, and relationship to patient

4. Information to be Released: Specific description of medical information to be released, including date ranges and types of records

5. Purpose of Disclosure: Clear statement of the reason for releasing the medical information

6. Duration of Authorization: Specific timeframe for which the authorization is valid

7. Patient Rights Statement: Statement of patient's rights under Swiss law, including right to revoke authorization and data protection rights

8. Signatures and Date: Space for patient or legal representative signature, date, and witness signature if required

Optional Sections

1. Legal Representative Authorization: Required when someone other than the patient is authorizing the release, including proof of authority

2. Specific Restrictions: Used when patient wants to exclude certain information from being released

3. Electronic Transfer Authorization: Required when records will be transferred electronically, including specific consent under EPRA

4. Research Use Authorization: Required when information might be used for research purposes, including specific provisions under HRA

5. Cross-Border Transfer Consent: Required when medical information will be transferred outside Switzerland

Suggested Schedules

1. List of Specific Records: Detailed inventory of specific medical records to be released, with dates and record types

2. Fee Schedule: If applicable, breakdown of any fees associated with the release of medical records

3. Identity Verification Documents: Copies of required identification documents for patient or legal representative

4. Privacy Notice: Detailed explanation of how the released information will be protected and handled under Swiss data protection laws

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

Medical Research

Pharmaceuticals

Education (Medical Institutions)

Occupational Health

Public Health

Social Services

Relevant Teams

Legal

Compliance

Medical Records

Patient Services

Privacy and Data Protection

Healthcare Operations

Administrative Services

Risk Management

Information Management

Clinical Operations

Relevant Roles

Medical Records Administrator

Privacy Officer

Healthcare Compliance Manager

Medical Practice Manager

Clinical Administrator

Legal Counsel

Data Protection Officer

Healthcare Provider

Insurance Claims Processor

Research Administrator

Medical Secretary

Patient Services Coordinator

Healthcare Operations Manager

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