Doctor Release Form

Doctor Release Form Template for Denmark

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Document background

The Doctor Release Form is a crucial document in the Danish healthcare system that facilitates the authorized sharing of patient medical information. It is required whenever patient medical records need to be transferred between healthcare providers or released to third parties such as insurance companies, employers, or other authorized recipients. The form ensures compliance with the Danish Health Act, Danish Authorization Act for Healthcare Professionals, and GDPR requirements. It includes comprehensive details about the scope of information being released, patient consent provisions, data protection measures, and the rights and responsibilities of all parties involved. This document is essential for maintaining patient privacy while enabling necessary information sharing in various situations such as continuing care, insurance claims, legal proceedings, or employment requirements.

Suggested Sections

1. Patient Information: Patient's full name, CPR number (Danish personal ID), contact details, and relevant medical record numbers

2. Healthcare Provider Information: Name, medical license number, and contact information of the healthcare provider/facility releasing the information

3. Scope of Release: Specific description of what medical information is being released, including time period covered

4. Purpose of Release: Clear statement of why the medical information is being released and who will receive it

5. Data Protection Notice: GDPR-compliant explanation of how the released information will be processed and protected

6. Patient Rights Statement: Information about the patient's rights under Danish law, including right to withdraw consent

7. Duration of Authorization: Timeframe for which the release authorization is valid

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

Optional Sections

1. Legal Representative Authorization: Required when someone other than the patient is authorizing the release (e.g., guardian, power of attorney)

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

3. Emergency Contact Information: Optional section for emergency contact details when relevant to the release purpose

4. Fee Information: Details about any applicable fees for records release, if relevant under Danish healthcare regulations

5. Translation Declaration: Required when the form is provided in multiple languages, confirming the Danish version prevails

Suggested Schedules

1. Schedule A - Detailed Medical Records List: Itemized list of specific medical records being released (e.g., test results, surgical records, prescriptions)

2. Schedule B - Third Party Recipients: List of authorized recipients of the medical information, including their contact details and purpose

3. Appendix 1 - Patient Rights Guide: Detailed information about patient rights under Danish healthcare law regarding medical records

4. Appendix 2 - Data Processing Information: Detailed GDPR-compliant information about how personal health data will be processed and protected

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