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Medical Records Consent Form
"I need a Medical Records Consent Form for our private clinic that allows sharing patient data with our research partners while ensuring GDPR compliance, specifically covering genetic testing results and long-term health monitoring data."
1. Patient Information: Full name, date of birth, NHS number, contact details and other identifying information of the patient
2. Healthcare Provider Details: Name, address, and contact information of the healthcare provider requesting consent
3. Scope of Consent: Detailed description of which medical records are covered and the specific purpose for access and use
4. Duration of Consent: Time period for which the consent remains valid, including start and end dates if applicable
5. Data Protection Notice: Information about how personal data will be processed, stored, protected and the patient's rights under data protection laws
6. Declaration and Signature: Patient's confirmation of understanding and explicit consent, including signature and date
1. Third Party Access Authorization: Section detailing permissions for specific third parties to access medical records, including their details and purpose of access
2. Representative Authorization: Section for cases where a representative acts on behalf of the patient, including legal authority verification
3. Research Use Consent: Additional permissions and conditions for use of medical records in research contexts
1. Privacy Notice: Detailed information about data protection rights, procedures, and compliance with GDPR and Data Protection Act 2018
2. Schedule of Record Types: Comprehensive list of specific medical record types covered by the consent
3. Authorized Persons Schedule: Detailed list of individuals or organizations authorized to access the records, including their roles and access levels
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