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Consent Form To Release Medical Information To A Third Party Template for England and Wales

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Key Requirements PROMPT example:

Consent Form To Release Medical Information To A Third Party

"I need a Consent Form To Release Medical Information To A Third Party for my insurance company to access my full medical history from London Bridge Hospital, with the consent period lasting for 6 months from March 2025."

Document background
The Consent Form To Release Medical Information To A Third Party is a crucial document in healthcare information management within England and Wales. It is used when medical records or information need to be shared with parties other than the direct healthcare provider, such as insurance companies, legal representatives, or other medical professionals. The form ensures compliance with data protection laws, particularly UK GDPR and the Data Protection Act 2018, while maintaining patient confidentiality. It provides clear documentation of the patient's explicit consent and helps healthcare providers manage liability risks associated with information sharing.
Suggested Sections

1. Patient Information: Full name, date of birth, address, and contact details of the patient

2. Healthcare Provider Details: Name and contact information of the healthcare provider holding the records

3. Third Party Information: Details of the person or organization to whom information will be released

4. Scope of Information: Specific medical information to be released and time period covered

5. Duration of Consent: Time period for which the consent remains valid

6. Declaration and Signature: Patient's confirmation and signature, including date

Optional Sections

1. Power of Attorney Details: Required when consent is given by someone other than the patient - used when the patient lacks capacity or has designated a legal representative

2. Specific Exclusions: Information that should NOT be shared - used when patient wants to restrict certain information from being shared

3. Purpose of Release: Specific reason for information sharing - used when information is being released for a specific purpose only

Suggested Schedules

1. Schedule 1: Detailed Medical Records List: Itemized list of specific records to be released

2. Appendix A: Power of Attorney Documentation: Copies of relevant legal authority documents

3. Appendix B: Identity Verification: Copies of identity documents for patient and/or third party

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions















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Relevant Industries
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Relevant Roles
Industries

UK General Data Protection Regulation (UK GDPR): Primary legislation governing personal data processing in the UK, including principles of data processing, legal basis for processing personal data, special category data requirements for medical data, and data subject rights

Data Protection Act 2018: UK implementation of GDPR including additional requirements for health data and safeguards for sensitive personal data processing

Access to Health Records Act 1990: Legislation governing rights of access to health records and regulations regarding deceased patients' records

Common Law Duty of Confidentiality: Legal principle establishing medical confidentiality obligations and patient consent requirements in healthcare settings

Mental Capacity Act 2005: Legislation addressing capacity to consent, power of attorney considerations, and best interests decision-making in healthcare contexts

The Caldicott Principles: Guidelines establishing protocols for handling patient information and information sharing in healthcare settings

NHS Act 2006: Statutory framework establishing obligations regarding patient information and NHS information governance

Human Rights Act 1998: Legislation incorporating Article 8 (right to privacy) and establishing framework for balancing rights and obligations in healthcare information sharing

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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