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Generic Printable Medical Records Release Authorisation Form Template for England and Wales

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Key Requirements PROMPT example:

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."

Document background
The Generic Printable Medical Records Release Authorisation Form is a essential document used in healthcare settings across England and Wales when patients need to authorize the release of their medical information. This form is designed to comply with UK data protection laws, including GDPR and the Data Protection Act 2018, while ensuring healthcare providers have proper authorization to share confidential medical information. It's particularly useful when medical records need to be transferred between healthcare providers, shared with insurance companies, or accessed by legal representatives. The form includes specific provisions for patient identification, record specification, and consent verification, making it a comprehensive tool for managing medical information releases.
Suggested Sections

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

Optional Sections

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

Suggested Schedules

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

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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Industries

UK General Data Protection Regulation (UK GDPR): Core data protection legislation covering principles of data processing, legal basis for processing, special category data protection, and data subject rights

Data Protection Act 2018: UK implementation of GDPR including specific provisions for health data and requirements for consent

Access to Health Records Act 1990: Legislation governing access to deceased patients' records and rights of personal representatives

Common Law Duty of Confidentiality: Legal principle establishing medical information confidentiality requirements and patient consent requirements

Mental Capacity Act 2005: Legislation covering provisions for patients lacking capacity and requirements for representatives/attorneys

The Health and Social Care Act 2012: Legislation establishing information governance requirements and NHS information handling protocols

The Medical Act 1983: Legislation setting out professional obligations regarding medical records

Human Rights Act 1998: Legislation incorporating European Convention rights into UK law, particularly Article 8 regarding right to privacy

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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