The Medical Records Transfer Form is a critical document used in New Zealand healthcare settings when patient medical records need to be transferred between healthcare providers. This form becomes necessary when patients change healthcare providers, seek specialist consultations, or require their medical history to be shared for continuing care. It ensures compliance with New Zealand's Privacy Act 2020 and Health Information Privacy Code 2020, while providing a standardized process for secure information transfer. The document includes essential sections for patient identification, provider details, specific record requests, and formal authorization, along with privacy statements and transfer method specifications. It serves as both a legal record of authorization and a practical tool for healthcare administrators to process record transfers efficiently.
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1. Patient Information: Essential demographic details including full name, date of birth, NHI number, current address, and contact information
2. Current Healthcare Provider Details: Information about the healthcare provider/facility currently holding the records, including name, address, contact details, and provider registration number
3. Requesting Healthcare Provider Details: Information about the healthcare provider/facility requesting the records, including name, address, contact details, and provider registration number
4. Records Request Specification: Detailed specification of which records are being requested (e.g., complete medical history, specific date range, particular medical episodes)
5. Transfer Method: Specification of how the records will be transferred (electronic/physical) and security measures to be implemented
6. Patient Authorization: Patient's consent section with declaration of understanding and authorization for the transfer
7. Privacy Statement: Statement outlining how the information will be handled in accordance with the Privacy Act 2020 and Health Information Privacy Code
1. Urgent Request Declaration: Additional section for cases requiring expedited transfer due to medical urgency
2. Third Party Authorization: Section to be included when someone other than the patient is authorizing the transfer (e.g., parent, guardian, power of attorney)
3. Special Handling Instructions: Section for any specific requirements for handling sensitive information or specific formats needed
4. Cost Authorization: Section detailing any associated costs and payment authorization if applicable
1. Schedule A - Record Index: Detailed list of all medical records being transferred
2. Schedule B - Transfer Checklist: Checklist for healthcare providers to ensure all required steps are completed
3. Appendix 1 - Privacy Notice: Detailed privacy notice explaining how personal health information will be handled
4. Appendix 2 - Supporting Documentation: Space for attaching any required supporting documents (e.g., ID verification, power of attorney)
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Practice Management
Hospital Administration
Mental Health Services
Allied Health Services
Aged Care
Primary Healthcare
Specialist Medical Services
Public Health
Private Healthcare
Emergency Medical Services
Relevant Teams
Medical Records
Administration
Compliance
Clinical Operations
Patient Services
Information Management
Privacy and Security
Healthcare Operations
Quality Assurance
Front Office Operations
Relevant Roles
Medical Administrator
Practice Manager
Healthcare Privacy Officer
Medical Records Coordinator
Clinical Director
General Practitioner
Medical Secretary
Health Information Manager
Compliance Officer
Healthcare Administrator
Medical Office Manager
Records Management Officer
Healthcare Operations Manager
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