Medical Release Form

Medical Release Form Template for Denmark

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Document background

The Medical Release Form is a crucial document in the Danish healthcare system, used when medical information needs to be shared between healthcare providers or with third parties. It serves as a formal authorization mechanism that complies with the Danish Health Act, Danish Patient Safety Act, and GDPR requirements. This document is essential when patients need their medical information transferred between healthcare providers, shared with insurance companies, or released to other authorized parties. The form must be used to ensure patient privacy rights are protected while facilitating necessary information sharing. It includes specific provisions for consent, data protection, and patient rights as required under Danish law, and can be particularly important in cases involving ongoing treatment, specialist referrals, or insurance claims.

Suggested Sections

1. Patient Information: Full legal name, CPR number (Danish personal identification number), address, and contact details of the patient

2. Healthcare Provider Information: Details of the healthcare provider/facility releasing the medical information, including name, address, and registration number

3. Recipient Information: Identity and contact details of the person or organization authorized to receive the medical information

4. Scope of Release: Specific description of what medical information is authorized for release, including time period covered

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

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

7. Rights and Revocation: Statement of patient's rights including the right to revoke authorization and how to do so

8. Data Protection Notice: GDPR-compliant information about how the medical data will be processed, stored, and protected

9. Signature Block: Space for patient's signature (or legal representative), date, and witness signature if required

Optional Sections

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

2. Special Categories of Data: Additional authorization sections for sensitive information like mental health records, HIV status, or genetic information

3. Emergency Contact Information: Contact details for emergency situations, particularly relevant for ongoing treatment authorizations

4. Language Declaration: Required when the form is provided in multiple languages or when an interpreter is used

5. Digital Consent Declaration: Required when the form is being completed and signed electronically

Suggested Schedules

1. Schedule A - Specific Records Checklist: Detailed checklist of specific medical records authorized for release

2. Schedule B - Third Party Recipients: List of additional authorized recipients if multiple parties are to receive the information

3. Appendix 1 - Privacy Notice: Detailed GDPR-compliant privacy notice explaining data processing practices

4. Appendix 2 - Patient Rights Information: Comprehensive explanation of patient rights under Danish healthcare law and GDPR

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