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Authorization Letter To Release Information Template
I need an Authorization Letter To Release Information Template for my medical records to be shared from Singapore General Hospital to my new specialist clinic in March 2025, ensuring compliance with healthcare privacy regulations and including specific conditions about the handling of diagnostic imaging.
1. Date: Current date of the authorization
2. Authorizing Party Details: Full name, identification details, and contact information of person giving authorization
3. Recipient Organization Details: Name and details of organization receiving the authorization
4. Purpose Statement: Clear statement of the purpose for which information is being released
5. Scope of Authorization: Specific types of information authorized for release
6. Duration: Validity period of the authorization
7. Signature Block: Space for signature and date of signing
1. Third Party Recipients: Details of any third parties authorized to receive the information - include when information may be shared with parties beyond the primary recipient
2. Revocation Clause: Terms for revoking the authorization - include when the authorizing party wants explicit right to cancel
3. Confidentiality Requirements: Specific handling requirements for the information - include when dealing with sensitive information requiring special handling
1. Identification Documents: Copies of relevant ID documents of the authorizing party
2. List of Authorized Information: Detailed list of specific records/information to be released
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