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Authorization To Release Information
"I need an Authorization To Release Information document for Singapore General Hospital to share my complete medical history with my new specialist at Mount Elizabeth Hospital, effective from March 1, 2025, for a duration of six months."
1. Authorizing Party Details: Full name, identification details, and contact information of the person giving authorization
2. Recipient Details: Identity and contact information of the party authorized to receive the information
3. Scope of Authorization: Specific description of information to be released and the extent of access granted
4. Duration of Authorization: Time period for which the authorization is valid, including start and end dates
5. Purpose of Disclosure: Clear statement of the intended purpose for which the information will be used
1. Third Party Recipients: Additional parties authorized to receive the information, used when multiple recipients are involved
2. Specific Restrictions: Any limitations on use or further disclosure of the information, included when specific restrictions are needed
3. Revocation Process: Detailed process for withdrawing authorization, included for longer-term authorizations
4. Data Protection Provisions: Specific provisions relating to PDPA compliance and data protection measures
1. Schedule A - Identity Verification Documents: Copies of identification documents of the authorizing party
2. Schedule B - Specific Information Schedule: Detailed list of specific information to be released when scope is complex
3. Schedule C - Authorization Matrix: Table showing different levels of access/information release if multiple recipients or information types are involved
4. Schedule D - Compliance Requirements: List of applicable regulatory requirements and compliance measures under Singapore law
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