General Medical Record Release Form

General Medical Record Release Form Template for Singapore

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Key Requirements PROMPT example:

"I need a General Medical Record Release Form for transferring my complete medical history from Singapore General Hospital to my new healthcare provider in Australia, ensuring compliance with both jurisdictions and including specific provisions for electronic transfer of radiological images."

Document background

The General Medical Record Release Form is essential in Singapore's healthcare system for managing the secure transfer of patient medical information. This document is required whenever patient records need to be shared between healthcare providers, insurance companies, legal representatives, or other authorized parties. It ensures compliance with Singapore's strict data protection laws, including the PDPA and Healthcare Services Act, while protecting patient privacy rights. The form includes specific details about the records to be released, timeframe, recipient information, and explicit patient consent.

Suggested Sections

1. Patient Information: Full name, NRIC/Passport number, contact details, date of birth of the patient

2. Healthcare Provider Details: Name and address of the healthcare facility releasing the records

3. Scope of Release: Specific medical records to be released and time period covered

4. Recipient Information: Details of person/entity authorized to receive the records

5. Authorization Statement: Clear consent statement and duration of authorization

6. Signature Block: Patient signature, date, and witness details

Optional Sections

1. Purpose of Disclosure: Section specifying why the medical records are being requested (e.g., insurance claims, legal proceedings, continuing care)

2. Fee Schedule: Section detailing any applicable charges for record retrieval and copying

3. Restriction Notes: Section specifying any restrictions on information release as requested by the patient

Suggested Schedules

1. Schedule A - Fee Schedule: Detailed breakdown of applicable charges for medical record retrieval and copying

2. Schedule B - List of Requested Records: Itemized list of specific medical records being requested

3. Schedule C - Identity Verification Requirements: List of required identification documents and verification procedures

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Insurance
Legal Services
Research Institutions

Relevant Teams

Medical Records
Compliance
Legal
Administration
Patient Services

Relevant Roles

Medical Records Officer
Healthcare Administrator
Compliance Officer
Medical Practice Manager
Data Protection Officer

Industries

Personal Data Protection Act (PDPA) 2012: Singapore's primary data protection legislation that governs the collection, use, disclosure and care of personal data. Critical for medical records as they contain sensitive personal information. Requires informed consent for data sharing and includes provisions for data transfer and security.

Private Hospitals and Medical Clinics Act (PHMCA): Regulatory framework that governs healthcare institutions in Singapore, setting standards for medical record keeping and establishing requirements for confidentiality.

SMC Ethical Code and Ethical Guidelines: Professional standards set by the Singapore Medical Council that outline requirements for medical records management, patient confidentiality, and proper documentation procedures.

Healthcare Services Act 2020: Updated regulatory framework for healthcare services that includes specific provisions for handling health information and requirements for licensing and compliance.

National Healthcare Group (NHG) Guidelines: Specific protocols and standards for handling patient information and the release of medical information within Singapore's healthcare system.

Patient Identification Requirements: Essential components for proper verification and identification of patients when releasing medical records.

Scope of Information Guidelines: Requirements for clearly defining what medical information can be released and under what circumstances.

Authorization Duration Standards: Guidelines for specifying the time period for which the medical record release authorization remains valid.

Revocation Rights: Legal requirements regarding the patient's right to revoke authorization for medical record release.

Purpose of Disclosure Requirements: Standards for documenting and specifying the intended purpose of medical record release.

Third Party Recipient Protocols: Guidelines for properly identifying and verifying third parties who may receive medical records.

Data Security Measures: Required security protocols and measures for protecting medical information during the release process.

Consent Requirements: Specific standards for obtaining and documenting patient consent for medical record release.

Fee Structure Guidelines: Regulations regarding any applicable fees for medical record release services.

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Authors

Alex Denne

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