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Authorisation For Release Of Health Records
"I need an Authorisation For Release Of Health Records to allow my new specialist at London Bridge Hospital to access my complete medical history from my previous GP practice, with the authorization valid from January 2025 to December 2025."
1. Patient Details: Full name, date of birth, NHS number, current address and contact information of the patient whose records are being requested
2. Authorisation Statement: Clear and explicit statement of consent for the release of medical records, including reference to relevant data protection legislation
3. Scope of Records: Detailed specification of which medical records are to be released, including relevant date ranges and types of information
4. Recipient Details: Complete information about who is authorized to receive the records, including organization name, address, and contact details
5. Time Period: Specification of the duration for which the authorization remains valid and expiry date if applicable
6. Declaration: Formal declaration section including patient signature, date, and witness information if required
1. Third Party Authorization: Additional section for cases where someone other than the patient is authorizing the release, including legal authority verification
2. Specific Exclusions: Section detailing any specific records or information that should be explicitly excluded from the release
3. Purpose of Release: Statement explaining the specific purpose for which the records are being requested and will be used
4. Data Protection Notice: Additional information about how the released information will be handled and protected under relevant data protection laws
1. Schedule 1 - Proof of Identity: Requirements and attached copies of required identification documents to verify the patient's identity
2. Schedule 2 - Power of Attorney Documentation: Where applicable, attached documentation proving authority to act on patient's behalf
3. Schedule 3 - Specific Record Request Form: Detailed form listing specific records requested, including dates and types of records
4. Schedule 4 - Fee Schedule: If applicable, details of any fees associated with the release of records
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