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The Authorization Letter For Medical Records is a crucial document in the Indonesian healthcare system, required whenever patient medical records need to be shared with third parties. This document is essential for compliance with Indonesian healthcare privacy laws, particularly Law No. 29 of 2004 on Medical Practice and Minister of Health Regulation No. 269/MENKES/PER/III/2008. It is commonly used when patients need to share their medical information for insurance claims, continuing treatment at different facilities, legal proceedings, or research purposes. The authorization letter must include specific patient identifiers, clear scope of authorization, and temporal validity, while ensuring proper protection of patient privacy rights under Indonesian law. Healthcare providers must verify the authenticity of these authorizations before releasing any medical records to ensure compliance with privacy regulations and protect patient confidentiality.

1. Letter Head / Date: Current date and medical facility's name and address where the records are held

2. Patient Information: Full legal name, date of birth, medical record number, national ID number (NIK), and current contact information of the patient

3. Authorized Recipient Information: Full details of the person or entity authorized to receive the medical records, including their relationship to the patient

4. Scope of Authorization: Specific description of which medical records are to be released, including date ranges and types of records

5. Purpose of Disclosure: Clear statement of why the medical records are being requested and how they will be used

6. Duration of Authorization: Specific timeframe for which the authorization is valid

7. Patient Declaration: Statement confirming the patient's voluntary authorization and understanding of the disclosure

8. Signature Block: Space for patient's signature, date of signing, and witness signature if required