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Simple Medical Release Form Template for England and Wales

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Key Requirements PROMPT example:

Simple Medical Release Form

"I need a Simple Medical Release Form that allows my GP to share my complete medical history with my insurance provider for the period January 2025 to December 2025, ensuring compliance with UK GDPR requirements."

Document background
The Simple Medical Release Form is essential for managing the secure and compliant transfer of medical information in England and Wales. This document is typically required when medical records need to be shared with third parties, such as insurance companies, legal representatives, or other healthcare providers. It ensures compliance with UK data protection laws and medical confidentiality requirements while providing a clear audit trail of patient consent. The form includes specific details about the information to be released, the duration of the authorization, and the intended recipients.
Suggested Sections

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

2. Healthcare Provider Details: Name and address of medical facility/provider releasing information

3. Scope of Release: Specific information being authorized for release

4. Authorization Statement: Clear consent statement for information release

5. Duration of Authorization: Time period for which the release is valid

6. Signature Block: Patient signature, date, witness signature if required

Optional Sections

1. Third Party Authorization: Additional section for when information is to be released to someone other than the patient

2. Mental Capacity Statement: Declaration section regarding patient's capacity to consent and details of authorized representative if applicable

3. Specific Exclusions: Section detailing any information explicitly excluded from the release authorization

Suggested Schedules

1. Identity Verification Documents: Schedule listing acceptable identification documents provided by the patient

2. Specific Records Schedule: Detailed itemization of specific medical 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












Clauses












Industries

Data Protection Act 2018 and UK GDPR: Primary legislation regulating the processing of personal data, including medical information. Requires specific consent for processing health data (special category data) and sets out data subject rights and privacy requirements.

Access to Health Records Act 1990: Legislation governing access to deceased patients' health records and specifies who can request access to medical records.

Mental Capacity Act 2005: Legislation relevant for cases where the patient may lack capacity to consent, including provisions for representatives/attorneys to act on behalf of patients.

Common Law Duty of Confidentiality: Legal principle establishing that medical information is inherently confidential and requires clear consent for disclosure.

NHS Act 2006: General framework for healthcare provision in the UK, including provisions about information sharing.

GMC Professional Guidelines: General Medical Council guidance on confidentiality and professional standards for handling medical information.

Caldicott Principles: Guidelines established for handling patient-identifiable information in the healthcare system.

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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