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Authorisation To Release Personal Information
"I need an Authorization To Release Personal Information for transferring my complete medical history from London Bridge Hospital to my new healthcare provider in Manchester, with the authorization valid from March 2025 to December 2025."
1. Data Subject Details: Full identification and contact information of the person whose information is being released, including name, address, date of birth, and any relevant identification numbers
2. Authorizing Party Declaration: Formal declaration by the person authorizing the release, including their capacity to authorize if different from data subject
3. Recipient Information: Complete details of the organization or individual authorized to receive the information, including contact details and any relevant registration numbers
4. Information to be Released: Specific description of the personal information authorized for release, including the nature and scope of the data
5. Purpose of Release: Clear statement of the specific purpose(s) for which the information may be used by the recipient
6. Duration of Authorization: Specific timeframe for which the authorization remains valid, including start and end dates
7. Data Protection Statements: Mandatory statements regarding data protection rights and obligations under UK GDPR and Data Protection Act 2018
8. Execution: Signature blocks, date, and witness requirements for formal execution of the authorization
1. Special Category Data Authorization: Additional specific authorization for sensitive personal data categories under Article 9 of UK GDPR, required when health, biometric, or other sensitive data is involved
2. Third Party Disclosure Authorization: Authorization for onward sharing of information with specified third parties, included when information may need to be shared beyond the primary recipient
3. Revocation Rights: Detailed process for withdrawing consent, included when the authorization is for ongoing or long-term access
4. International Transfer Provisions: Additional provisions required when personal data may be transferred outside the UK, addressing international data transfer requirements
1. Schedule 1 - Categories of Personal Data: Detailed itemization of all specific categories of personal data covered by the authorization
2. Schedule 2 - Authorized Recipients: List of specific individuals or roles within the recipient organization authorized to access the information, if applicable
3. Appendix A - Identity Verification: Copies or details of identification documents used to verify the data subject's identity
4. Appendix B - Processing Activities: Detailed description of how the authorized information will be processed, stored, and protected by the recipient
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