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Doctor Release Form Template for England and Wales

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Key Requirements PROMPT example:

Doctor Release Form

"I need a Doctor Release Form to authorize the release of my medical records from London Bridge Hospital to my insurance company for a claim related to my surgery in March 2025, with the authorization valid for 3 months."

Document background
The Doctor Release Form is a critical document used in healthcare settings across England and Wales when medical information needs to be shared with third parties. This form ensures compliance with the Data Protection Act 2018, UK GDPR, and medical confidentiality requirements while protecting both healthcare providers and patients. It's essential when medical records need to be transferred between healthcare providers, shared with insurance companies, or released for legal proceedings. The form typically includes patient identification details, scope of information to be released, intended recipient details, and explicit consent declarations.
Suggested Sections

1. Patient Information: Patient's full name, date of birth, address, NHS number and other identifying details

2. Doctor Information: Doctor's name, GMC number, practice details and professional information

3. Purpose of Release: Clear statement of the specific reason for information release and intended use

4. Scope of Release: Detailed description of exactly what medical information is being authorized for release

5. Recipient Details: Complete information about who is authorized to receive the medical information

6. Duration of Authorization: Specific time period for which the release authorization remains valid

7. Consent Statement: Formal statement of patient consent including acknowledgment of understanding

Optional Sections

1. Third Party Authorization: Additional section for cases where someone other than the patient is authorizing the release (e.g., for minors or patients lacking capacity)

2. Specific Exclusions: Section detailing any specific medical information that is explicitly not to be released

3. Emergency Contact Information: Alternative contact details for urgent matters or emergency situations

Suggested Schedules

1. Identity Verification Documents: Copies of identification documents used to verify the patient's identity

2. Proof of Authority Documentation: Legal documentation proving authority to act on patient's behalf, where applicable

3. Specific Records List: Detailed inventory of specific medical records authorized for release

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



















Clauses















Relevant Industries
Relevant Teams
Relevant Roles
Industries

Data Protection Act 2018 and UK GDPR: Primary legislation governing the handling of personal and medical data, including requirements for consent, data sharing, and patient rights regarding their medical information

Access to Health Records Act 1990: Legislation regulating access to deceased patients' medical records and rights of personal representatives and those with claims

Medical Act 1983: Establishes professional standards for medical practitioners and provides the regulatory framework for medical practice

National Health Service Act 2006: Provides the framework for NHS services and outlines patient rights and responsibilities

Mental Capacity Act 2005: Addresses considerations for patients lacking capacity to consent and requirements for legitimate decision-making

Human Rights Act 1998: Ensures protection of fundamental rights including right to privacy, healthcare, and personal information

General Medical Council Guidelines: Professional standards, confidentiality requirements, and record-keeping obligations for medical practitioners

Common Law Duty of Confidentiality: Establishes doctor-patient confidentiality obligations and circumstances where disclosure is permitted

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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