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Release Of Medical Information To A Family Member Form Template for England and Wales

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Key Requirements PROMPT example:

Release Of Medical Information To A Family Member Form

"I need a Release Of Medical Information To A Family Member Form that allows my sister to access my complete medical history and ongoing treatment records from January 2025, as she will be my primary caregiver following my scheduled surgery."

Document background
The Release Of Medical Information To A Family Member Form is a crucial document used when patients need to give formal permission for their medical information to be shared with specific family members. This document, governed by English and Welsh law, ensures compliance with data protection regulations while facilitating necessary information sharing in healthcare settings. It's particularly important when family members need to assist with medical care, make informed decisions, or handle healthcare administration. The form includes specific provisions for information access, time limitations, and confidentiality requirements, all while maintaining compliance with UK GDPR and healthcare regulations.
Suggested Sections

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

2. Authorized Family Member Details: Full name, relationship to patient, contact information

3. Scope of Authorization: Specific medical information authorized for release

4. Duration of Authorization: Time period for which the authorization is valid

5. Consent Declaration: Express consent statement and signature block

Optional Sections

1. Mental Capacity Declaration: Used when patient lacks capacity to consent, includes details of person with authority to consent

2. Emergency Contact Protocol: Special instructions for emergency situations

3. Additional Authorized Recipients: Used when multiple family members need access

4. Specific Exclusions: Details of any information explicitly excluded from the authorization

Suggested Schedules

1. Proof of Identity: Copies of ID documents for both patient and authorized family member

2. Power of Attorney Documentation: If applicable, copy of lasting power of attorney or court order

3. Specific Medical Records List: Detailed list of specific 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

























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Relevant Industries
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UK General Data Protection Regulation (UK GDPR): Primary legislation regulating personal data processing, defining special category data (including health data), establishing lawful bases for processing, and setting out data subject rights.

Data Protection Act 2018: UK law that implements and supplements the UK GDPR, containing specific provisions for health data and additional safeguards for sensitive data processing.

Access to Health Records Act 1990: Legislation governing access to deceased patients' medical records, particularly relevant when family members seek access to deceased relatives' information.

Mental Capacity Act 2005: Key legislation for situations where patients lack capacity to consent, defining decision-making authority and framework for lasting powers of attorney.

Common Law Duty of Confidentiality: Fundamental legal principle in healthcare requiring explicit consent for sharing confidential information between parties.

NHS Act 2006: Contains specific provisions regarding confidentiality and information sharing within NHS organizations.

Caldicott Principles: While not legislation, these are widely adopted guidelines and standards for handling patient information in the healthcare sector.

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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