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Authorization Letter To Disclose Information
"I need an Authorization Letter To Disclose Information for my medical records to be shared from Singapore General Hospital to my new specialist clinic in Australia, valid from March 2025 to December 2025, with specific provisions for cross-border data transfer."
1. Date and Location: Current date and place of execution
2. Authorizing Party Details: Full name, identification, contact details of person giving authorization
3. Recipient Details: Details of entity/person authorized to receive information
4. Scope of Authorization: Specific information authorized for disclosure
5. Purpose of Disclosure: Clear statement of why information is being disclosed
6. Duration of Authorization: Validity period of the authorization
7. Signature Block: Space for signature and witness details
1. Confidentiality Requirements: Additional confidentiality obligations for recipient when sensitive information is involved
2. Revocation Clause: Terms for revoking the authorization when authorization needs to be revocable
3. Third Party Disclosure: Permission/restrictions for further disclosure when information might need to be shared beyond immediate recipient
1. List of Authorized Information: Detailed list of specific documents/information covered
2. Identity Verification Documents: Copies of identification documents of authorizing party
3. Supporting Documents: Any relevant supporting documentation referenced in the letter
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