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Release of Information Form
I need a Release of Information Form that authorizes the sharing of my medical records with a third-party organization for the purpose of a health assessment, ensuring compliance with local privacy laws and specifying a validity period of one year.
What is a Release of Information Form?
A Release of Information Form gives your formal permission to share private information about you with others. In Indonesia, these forms play a vital role under Law No. 11 of 2008 on Electronic Information and Transactions, especially when handling sensitive personal or medical data.
The form specifies exactly what information can be shared, who can receive it, and how long the permission lasts. Healthcare providers, banks, and government agencies across Indonesia commonly use these forms to protect both the organization and the individual's privacy rights. You'll often need to sign one before your medical records, financial details, or employment history can be sent to another party.
When should you use a Release of Information Form?
Use a Release of Information Form when another organization needs access to confidential data about you or your business. Common situations include applying for bank loans (where lenders need financial records), transferring medical files between hospitals, or providing employment history to potential employers in Indonesia.
Indonesian law requires these forms for sharing sensitive personal data across organizations. They're especially important when dealing with government agencies, insurance companies, or during legal proceedings. Getting the form signed early prevents delays and compliance issues later—particularly under Indonesia's Electronic Information and Transaction Law, which carries strict penalties for unauthorized data sharing.
What are the different types of Release of Information Form?
- Medical Records Release Form: Specifically designed for healthcare providers to share patient records, test results, and treatment histories between facilities
- Patient Information Release Form: Broader than medical records, covers sharing demographic data, insurance details, and care preferences with third parties
- Photography Consent Form: Authorizes use of photos or videos, often used by businesses and media companies for marketing or publications
- Release Form: General-purpose template adaptable for various information types, commonly used in business settings
- Patient Release Form: Combines medical release with liability waivers, typically used before procedures or treatments
Who should typically use a Release of Information Form?
- Healthcare Providers: Generate and manage Release of Information Forms when sharing patient data with specialists, insurers, or other medical facilities
- Patients: Review and sign forms to authorize the release of their medical records, test results, or treatment histories
- Financial Institutions: Request and process forms when sharing customer financial data with credit agencies or other banks
- HR Departments: Handle employee information releases for background checks, employment verification, or benefit enrollment
- Legal Professionals: Draft and review forms to ensure compliance with Indonesian privacy laws and data protection regulations
- Government Agencies: Process forms when requesting or sharing citizen data across departments or with private organizations
How do you write a Release of Information Form?
- Identify Parties: Gather complete details of who's releasing information and who's receiving it, including legal names and contact information
- Define Scope: List exactly what information will be shared, avoiding broad or vague descriptions
- Set Time Limits: Specify how long the authorization remains valid under Indonesian law
- Purpose Statement: Clearly explain why the information is being released and how it will be used
- Legal Requirements: Include mandatory disclaimers and privacy notices required by Indonesian data protection laws
- Signature Fields: Add spaces for dates, signatures, and witness details if needed
- Format Check: Our platform ensures your form includes all required elements in compliance with local regulations
What should be included in a Release of Information Form?
- Party Information: Full legal names and addresses of both the information provider and recipient
- Data Scope: Specific description of information being released, avoiding general terms
- Purpose Statement: Clear explanation for why the information is being shared
- Duration Clause: Explicit timeframe for how long the release remains valid
- Privacy Notice: Statement complying with Indonesia's data protection requirements
- Revocation Rights: Terms explaining how and when consent can be withdrawn
- Signature Block: Space for dated signatures, witness details, and official stamps
- Governing Law: Reference to Indonesian law and jurisdiction
- Compliance Statement: Confirmation of adherence to Law No. 11 of 2008 on Electronic Information
What's the difference between a Release of Information Form and an Authorization Form?
A Release of Information Form differs significantly from an Authorization Form in several key ways, though they're often mistakenly used interchangeably in Indonesia. While both involve granting permissions, their scope and application vary considerably.
- Purpose and Scope: Release forms specifically focus on sharing existing information with third parties, while Authorization Forms grant permission for future actions or decisions
- Duration of Effect: Release forms typically cover a one-time transfer of specific information, whereas Authorization Forms often establish ongoing permissions
- Legal Requirements: Under Indonesian law, Release forms must detail exactly what information is being shared, while Authorization Forms can be broader in scope
- Usage Context: Release forms are common in healthcare and educational settings for sharing records, while Authorization Forms are more frequently used in financial and business contexts
- Revocation Process: Release forms usually expire after the information is shared, but Authorization Forms often require formal revocation to terminate
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