Share Medical Information Form

Share Medical Information Form Template for Switzerland

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Key Requirements PROMPT example:

"I need a Share Medical Information Form that allows my Zurich-based medical clinic to share patient records with multiple specialists across different cantons, with specific provisions for electronic health record sharing and a validity period until December 2025."

Document background

The Share Medical Information Form is a critical document used in Swiss healthcare settings when there is a need to share patient medical information between different healthcare providers or authorized parties. This form is essential for maintaining compliance with Swiss data protection laws, particularly the FADP/DSG and EPRA/EPDG, while facilitating necessary medical information exchange. It becomes relevant when patients require coordinated care across multiple providers, during referrals, for insurance purposes, or in research contexts. The document ensures that sensitive medical data is shared securely and legally, with explicit patient consent, while preserving patient rights and privacy protections under Swiss law. Healthcare providers must use this form to document patient authorization before sharing any protected health information with third parties.

Suggested Sections

1. Patient Information: Full legal name, date of birth, address, contact details, and health insurance information of the patient

2. Healthcare Provider Details: Information about the primary healthcare provider/facility authorized to share the information

3. Authorized Recipients: List of healthcare providers, institutions, or individuals authorized to receive the medical information

4. Scope of Authorization: Specific medical information authorized for sharing, including time period covered

5. Purpose of Disclosure: Clearly stated purpose(s) for which the medical information may be shared

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

7. Patient Rights: Statement of patient's rights including right to revoke authorization and receive copies

8. Signatures: Spaces for patient signature (or legal representative) and date, with witness signature if required

Optional Sections

1. Legal Representative Authorization: Required when the form is signed by someone other than the patient (e.g., parent, guardian, power of attorney)

2. Specific Exclusions: Section listing any specific medical information that should NOT be shared

3. Emergency Contact: Optional section for emergency contact information

4. Electronic Records Consent: Additional consent specifically for electronic sharing of records, required if electronic sharing is anticipated

5. Language Confirmation: Required for non-native speakers, confirming the form has been explained in a language they understand

Suggested Schedules

1. List of Authorized Information: Detailed checklist of specific medical information types authorized for sharing (e.g., test results, medications, diagnoses)

2. Recipient Details: Detailed information about each authorized recipient, including contact details and professional credentials

3. Privacy Notice: Summary of relevant privacy laws and patient rights under Swiss law

4. Revocation Form: Template form for revoking the authorization if needed

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

Medical Research

Pharmaceuticals

Elder Care

Mental Health

Rehabilitation Services

Public Health

Healthcare Technology

Medical Education

Relevant Teams

Legal

Compliance

Medical Records

Patient Administration

Data Protection

Clinical Operations

Quality Assurance

Risk Management

Patient Services

Information Technology

Relevant Roles

Medical Director

Hospital Administrator

Privacy Officer

Data Protection Officer

Healthcare Compliance Manager

Medical Records Manager

Clinical Director

General Practitioner

Medical Secretary

Legal Counsel

Healthcare Risk Manager

Patient Relations Coordinator

Insurance Coordinator

Research Coordinator

Medical Office Manager

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