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Universal Medical Release Form Template for England and Wales

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Key Requirements PROMPT example:

Universal Medical Release Form

"I need a Universal Medical Release Form to authorize my GP to share my complete medical history with my new specialist consultant at London Bridge Hospital, with the authorization valid from January 2025 to December 2025."

Document background
The Universal Medical Release Form is essential for managing the sharing of medical information in England and Wales. It serves as a standardized authorization document that enables patients or their representatives to grant specific permissions for the release of medical records. This form is particularly important in situations requiring the transfer of medical information between healthcare providers, insurance companies, legal representatives, or other authorized parties. It includes comprehensive details about the scope of information to be released, duration of authorization, and specific conditions for use, while ensuring compliance with UK data protection laws and healthcare regulations.
Suggested Sections

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

2. Authorization Statement: Clear statement of consent for release of medical information

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

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

5. Recipient Information: Details of authorized recipients of the medical information

6. Patient Rights Statement: Information about right to revoke and data protection rights

7. Signature Block: Patient signature, date, witness requirements

Optional Sections

1. Mental Capacity Declaration: Section to be included when release is signed by someone other than patient due to mental capacity issues or appointed representation

2. Specific Exclusions: Section for listing information specifically excluded from the release authorization

3. Emergency Contact: Section for additional contact points when alternative contacts are needed

Suggested Schedules

1. Schedule 1 - Specific Records: Detailed list of specific medical records to be released

2. Schedule 2 - Authorized Recipients: Detailed list of all authorized recipients and their access levels

3. Appendix A - Patient Rights: Detailed explanation of patient rights under data protection laws

4. Appendix B - Proof of Identity: Requirements for identity verification

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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Relevant Roles
Industries

Data Protection Act 2018 and UK GDPR: Primary legislation governing personal data processing, including special category health data. Establishes requirements for explicit consent, data subject rights, and core data protection principles for medical information handling.

Access to Health Records Act 1990: Legislation that specifically regulates access to deceased patients' health records and defines the categories of individuals who have the right to request such access.

Mental Capacity Act 2005: Framework for making decisions on behalf of individuals who lack capacity, including provisions for lasting powers of attorney and best interests decision-making in medical contexts.

Health and Social Care Act 2012: Establishes the framework for healthcare information sharing and confidentiality requirements within the healthcare system.

Common Law Duty of Confidentiality: Legal principle establishing medical confidentiality and the circumstances under which disclosure of medical information is permitted.

Human Rights Act 1998: Incorporates Article 8 right to privacy and requires balancing privacy rights with other interests in medical information sharing.

NHS Act 2006: Provides statutory framework for healthcare services and establishes information governance requirements for the National Health Service.

Professional Guidelines: Includes GMC guidance on confidentiality, NHS Information Governance requirements, and Caldicott Principles for handling medical information.

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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