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Authorisation To Release Information To Family Members
"I need an Authorisation To Release Information To Family Members document that allows my sister and adult daughter to access my medical records from St. Mary's Hospital during my planned surgery and recovery period from March to June 2025."
1. Authorizer Details: Full name, contact information, and identification of the person giving authorization
2. Authorized Family Members: Names, relationships, and contact details of family members permitted to access information
3. Scope of Authorization: Specific types of information that can be released and any limitations
4. Duration: Time period for which the authorization remains valid
5. Revocation Rights: Statement of right to withdraw authorization and process for doing so
1. Emergency Contacts: Additional emergency contacts section, used when immediate family is unavailable
2. Special Instructions: Any specific conditions or restrictions on information sharing
3. Digital Access: Authorization for online portal access, if applicable
1. Identity Verification: Copies of ID documents for authorizer and authorized family members
2. Proof of Relationship: Documents proving family relationship where required
3. Specific Information Lists: Detailed lists of specific information types that can be accessed
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