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1. Patient Information: Full legal name, date of birth, contact details, and NHI (National Health Index) number of the patient whose records are being authorized for release
2. Authorizing Party Details: If different from the patient, details of the person authorizing the release, including their relationship to the patient and contact information
3. Recipient Information: Name, role/organization, and contact details of the healthcare provider or entity authorized to receive the medical records
4. Scope of Authorization: Specific description of what medical records are being authorized for release, including date ranges and types of information
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 time period for which the authorization is valid
7. Signature and Date: Space for authorizing party's signature and date of signing
1. Special Categories of Information: Additional specific authorization for sensitive information such as mental health records, HIV status, or substance abuse treatment records
2. Legal Representative Authorization: Required when the authorizing party is not the patient but has legal authority (e.g., parent, guardian, power of attorney)
3. Revocation Rights: Statement explaining the right to revoke the authorization and the process for doing so
4. Re-disclosure Notice: Statement about potential re-disclosure of information by the recipient
5. Digital Communication Consent: Optional authorization for sending records via email or other electronic means
1. Identity Verification Documents: Copies of required identification documents (e.g., passport, driver's license) to verify the identity of the authorizing party
2. Proof of Legal Authority: If applicable, documents proving legal authority to access records (e.g., power of attorney, court order, proof of guardianship)
3. Specific Records List: Detailed list of specific medical records being requested, if applicable
Healthcare
Medical Services
Legal Services
Insurance
Social Services
Medical Research
Healthcare Administration
Aged Care
Mental Health Services
Public Health
Legal
Compliance
Medical Records
Patient Services
Administrative Services
Health Information Management
Clinical Operations
Privacy and Data Protection
Customer Service
Quality Assurance
Medical Records Officer
Healthcare Administrator
Privacy Officer
Compliance Manager
Medical Secretary
Practice Manager
Legal Counsel
Healthcare Provider
Insurance Claims Processor
Medical Research Coordinator
Clinical Administrative Assistant
Health Information Manager
Patient Services Coordinator
Medical Office Manager
Healthcare Compliance Officer
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ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it


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