Psychologist Release Of Information Form

Psychologist Release Of Information Form Template for Denmark

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Document background

The Psychologist Release Of Information Form is a essential document used in Danish healthcare settings when there is a need to share psychological records or information with third parties. This form is required under Danish law whenever psychological information needs to be disclosed outside the immediate therapeutic relationship, whether for continued care, legal proceedings, insurance purposes, or other authorized reasons. The document ensures compliance with the Danish Psychology Act, Danish Healthcare Documentation Act, and GDPR requirements for processing sensitive personal data. It provides a structured way to obtain and document informed consent, specify the scope and duration of the authorization, and protect both the patient's rights and the psychologist's professional obligations. The form is particularly important given the sensitive nature of psychological information and the strict data protection requirements in Denmark.

Suggested Sections

1. Identification of Parties: Details of the patient (data subject), the psychologist, and the recipient(s) of the information, including names, contact details, and relevant identification numbers

2. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the information is being released

3. Information to be Released: Detailed description of what specific information will be shared, including date ranges and types of records

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

5. Rights and Notifications: Statement of patient rights including right to revoke consent, data protection rights under GDPR, and any limitations

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

Optional Sections

1. Special Categories of Data: Additional consent section for sensitive information such as substance abuse, HIV status, or genetic information

2. Minor/Guardian Authorization: Required when the patient is under 18 or has a legal guardian

3. Electronic Communication Consent: Additional authorization for sharing information via electronic means

4. Re-disclosure Notice: Statement regarding potential re-disclosure by the receiving party, if applicable

5. Payment Information: Required when release of information involves payment or insurance matters

Suggested Schedules

1. Detailed Record List: Itemized list of specific documents/records to be released

2. Recipient Information Sheet: Detailed information about all authorized recipients and their contact details

3. Privacy Notice: Detailed privacy notice explaining how the information will be handled, as required by GDPR

4. Revocation Form: Template form for future revocation of consent if needed

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