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Authorization Letter For Medical Abstract
"I need an Authorization Letter For Medical Abstract to allow Singapore General Hospital to release my complete medical history from the past five years to my insurance company (AIA Singapore) for a claim processing due by March 2025."
1. Patient Information: Full name, NRIC/FIN, date of birth, contact details of the patient
2. Healthcare Provider Details: Name and address of the healthcare institution from which the medical abstract is requested
3. Scope of Authorization: Specific medical information authorized for release, including time period covered
4. Recipient Information: Details of person/entity authorized to receive the medical information
5. Duration of Authorization: Validity period of the authorization and expiry date
6. Declaration and Signature: Patient's consent statement, acknowledgment of terms, and signature
1. Purpose of Disclosure: Specific reason for requesting medical abstract, required when receiving institution needs this information
2. Third Party Authorization: Details of person authorized to act on patient's behalf, used when patient cannot provide authorization directly
3. Witness Section: Information and signature of witness, required for vulnerable patients or when mandated by healthcare provider
1. Identity Documents: Copies of required identification documents (NRIC/passport)
2. Power of Attorney: Legal documentation authorizing third party to act on patient's behalf
3. Supporting Documents: Additional documents such as proof of relationship for next-of-kin authorizations
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