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Consent To Disclose Personal Information Form
"I need a Consent To Disclose Personal Information Form for my medical practice to share patient records with a specialist research facility, ensuring compliance with special category data requirements and including an option for patients to withdraw consent by March 2025."
1. Individual's Details: Full name, contact information, and any relevant identification details of the person giving consent
2. Purpose of Disclosure: Clear explanation of why the information is being disclosed and how it will be used
3. Information to be Disclosed: Specific details of what personal information will be shared
4. Recipients: Identity of organizations/individuals who will receive the information
5. Duration: How long the consent remains valid
6. Withdrawal Rights: Information about the right to withdraw consent and how to do so
7. Declaration: Formal statement of consent and signature section
1. Special Category Data: Additional declarations for sensitive personal data, used when disclosing health, racial, religious, or similar sensitive data
2. Third Party Authority: Used when consent is given by someone with authority to act on behalf of the data subject
3. International Transfers: Required when data will be transferred outside the UK
1. Privacy Notice: Detailed information about how the personal data will be processed
2. List of Third Parties: Comprehensive list of all organizations who may receive the information, if multiple recipients
3. Data Categories: Detailed breakdown of specific data fields to be shared, if extensive
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