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The Consent To Release Medical Information Form is a critical document within Qatar's healthcare system, designed to facilitate the legal and secure transfer of patient medical information while maintaining compliance with Qatar's strict medical privacy laws and data protection regulations. This document becomes necessary when medical information needs to be shared between healthcare providers, with insurance companies, or with other authorized parties. The form ensures that patients maintain control over their medical information while providing healthcare providers with clear authorization for information sharing. It includes comprehensive details about the scope of information to be released, the duration of the authorization, and specific use limitations, all aligned with Qatar's healthcare regulatory framework and international best practices for medical information handling.

1. Patient Information: Complete identification details of the patient including full name, date of birth, Qatar ID number, contact information, and medical record number

2. Healthcare Provider Details: Information about the healthcare provider/facility currently holding the medical records, including name, address, and contact information

3. Recipient Information: Details of the person or entity to whom the medical information will be released, including name, address, contact information, and relationship to patient

4. Scope of Information: Specific description of medical information to be released, including date ranges and types of records (e.g., consultation notes, test results, imaging reports)

5. Purpose of Disclosure: Clear statement of the reason for releasing the medical information

6. Duration of Consent: Specification of how long the consent remains valid

7. Patient Rights Statement: Information about the patient's rights regarding the consent, including the right to revoke

8. Authorization Statement: Formal declaration of consent and understanding of the terms

9. Signature Block: Space for patient signature, date, and witness signature if required