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Generic Printable Medical Records Release Authorisation Form
"I need a Generic Printable Medical Records Release Authorisation Form that allows my elderly mother's complete medical history to be transferred from London Bridge Hospital to her new care home in Wales, with specific provisions for her power of attorney holder to manage future records requests."
1. Patient Information: Full name, date of birth, address, contact details, NHS number
2. Healthcare Provider Details: Name and address of the healthcare provider holding the records
3. Records Request Specification: Type and date range of records being requested
4. Recipient Information: Details of where/to whom records should be sent
5. Authorization Statement: Express consent for release of records
6. Duration of Authorization: Time period for which authorization remains valid
1. Third Party Authorization: Additional section required when records are to be released to someone other than the patient
2. Legal Representative Details: Information about person with legal authority to request records (e.g., power of attorney)
3. Specific Exclusions: Section for specifying any records to be excluded from release
1. Proof of Identity: Requirements and checklist for acceptable ID documents
2. Proof of Authority: Requirements for legal documents proving authority to request records
3. Fee Schedule: Schedule of costs associated with record copying and release, if applicable
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