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Printable Medical Records Release Authorisation Form Template for England and Wales

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Key Requirements PROMPT example:

Printable Medical Records Release Authorisation Form

"I need a Printable Medical Records Release Authorisation Form to authorize the transfer of my complete medical history from London Bridge Hospital to my new GP practice in Manchester, ensuring all records from January 2025 onwards are included."

Document background
The Printable Medical Records Release Authorisation Form is essential for managing the secure transfer of medical information in England and Wales. This document is required whenever a patient or their authorized representative needs to share medical records with third parties, such as other healthcare providers, insurance companies, or legal representatives. It ensures compliance with UK data protection laws, including GDPR and the Data Protection Act 2018, while protecting patient confidentiality. The form includes specific details about the records to be released, time periods covered, and the intended recipient, providing a clear audit trail for medical information transfers.
Suggested Sections

1. Patient Information: Full name, date of birth, address, contact details, NHS number

2. Records Holder Information: Healthcare provider/facility details holding the records

3. Recipient Information: Details of person/organization to receive the records

4. Scope of Authorization: Specific records authorized for release and date range

5. Authorization Statement: Legal statement of consent for release

6. Duration of Authorization: Validity period of the authorization

7. Signature Block: Patient/authorized representative signature and date

Optional Sections

1. Representative Authorization: Additional section required when the request is made by a legal representative or guardian rather than the patient themselves

2. Specific Exclusions: Optional section for when the patient wants to restrict certain information from being released

3. Purpose of Release: Section specifying the reason for requesting records, used when tracking is required for audit purposes

Suggested Schedules

1. Proof of Identity Requirements: Schedule listing required identification documents and acceptable forms of ID

2. Legal Authority Documentation: Schedule detailing requirements for power of attorney or court orders if applicable

3. Fee Schedule: Schedule outlining any applicable charges for record copies and payment terms

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


















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 requirements, and data subject rights in the UK

Data Protection Act 2018: UK's implementation of GDPR including additional requirements for health data and specific provisions for medical records

Access to Health Records Act 1990: Legislation governing access to health records, particularly relevant for deceased patients' records and rights of access to health records

Mental Capacity Act 2005: Legislation addressing considerations for patients lacking capacity and requirements for representatives/attorneys in medical decision-making

Common Law Duty of Confidentiality: Legal principle covering medical confidentiality obligations and patient consent requirements

NHS Act 2006: Statutory framework outlining obligations regarding health records and NHS information governance requirements

Professional Guidelines: Guidance from regulatory bodies including General Medical Council (GMC), British Medical Association (BMA), and NHS Digital guidelines

Health and Social Care Act 2012: Legislation covering information governance requirements and health service regulations

Caldicott Principles: Set of principles governing confidentiality and information sharing in healthcare settings

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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