The Medical Records Transfer Form is a critical document used in Saudi Arabian healthcare settings to facilitate the secure and compliant transfer of patient medical records between healthcare providers. This document becomes necessary when patients change healthcare providers, seek second opinions, or require their medical information to be shared for continuing care. The form ensures compliance with Saudi Arabian healthcare regulations, including the Law of Healthcare Information and Digital Health, while protecting patient privacy and maintaining proper documentation chains. It includes comprehensive patient identification, detailed specification of requested records, authorization protocols, and timing requirements. The document addresses both routine transfers and special circumstances such as urgent medical needs or transfers requiring guardian authorization.
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1. Patient Information: Complete demographic details including full name (in Arabic and English), national ID/Iqama number, date of birth, contact information
2. Requesting Facility Details: Information about the healthcare facility requesting the records, including license number and contact details
3. Releasing Facility Details: Information about the healthcare facility releasing the records, including license number and contact details
4. Records Requested: Specific details of the medical records being requested, including date ranges and types of records
5. Patient Authorization: Express consent from the patient for the transfer of records, including signature and date
6. Purpose of Transfer: Statement of the medical or legal reason for requesting the records transfer
7. Verification of Identity: Confirmation of how patient identity was verified during the request process
8. Timeline Requirements: Specified timeframe for the transfer of records to be completed
1. Guardian Authorization: Required when the patient is a minor or legally incompetent, including guardian's details and relationship to patient
2. Urgent Request Designation: Used when records are needed urgently for emergency medical care
3. Third Party Authorization: When records are being requested by a third party with patient authorization
4. International Transfer Details: Required for transfers to facilities outside Saudi Arabia, including additional compliance requirements
5. Special Records Designation: For sensitive medical information requiring additional authorization (e.g., psychiatric records, genetic testing)
6. Payment Information: When fees apply for record transfer services
1. Schedule A - Types of Medical Records: Detailed checklist of specific medical record types being requested (e.g., lab results, imaging reports, prescription history)
2. Schedule B - Identity Verification Documents: List of acceptable identification documents and copies attached
3. Schedule C - Fee Schedule: Breakdown of any applicable fees for record transfer services
4. Appendix 1 - Patient Rights Information: Summary of patient rights regarding medical records under Saudi law
5. Appendix 2 - Records Transfer Procedure: Step-by-step process for how records will be transferred and secured
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Hospital Administration
Clinical Practice
Medical Records Management
Healthcare Information Technology
Healthcare Compliance
Public Health
Relevant Teams
Medical Records
Patient Services
Compliance
Healthcare Administration
Quality Assurance
Information Management
Clinical Operations
Patient Relations
Documentation
Legal Affairs
Relevant Roles
Medical Records Administrator
Healthcare Facility Manager
Compliance Officer
Medical Director
Patient Services Coordinator
Healthcare Information Manager
Clinical Administrator
Medical Records Clerk
Privacy Officer
Healthcare Operations Manager
Patient Relations Manager
Medical Secretary
Healthcare Documentation Specialist
Quality Assurance Manager
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