Medical Records Release Form

Medical Records Release Form Template for Singapore

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Key Requirements PROMPT example:

"I need a Medical Records Release Form for Singapore General Hospital to release my complete medical history from 2020-2025 to my new specialist at Mount Elizabeth Hospital, with specific provisions for sharing diagnostic imaging and test results."

Document background

The Medical Records Release Form is essential in Singapore's healthcare ecosystem where strict data protection laws govern the handling of medical information. This document is used when patients or their authorized representatives need to grant permission for the transfer of medical records between healthcare providers, insurance companies, or other authorized parties. It includes specific details about the records to be released, the purpose of disclosure, and the duration of authorization, ensuring compliance with the Personal Data Protection Act 2012, Healthcare Services Act 2020, and relevant medical practice guidelines.

Suggested Sections

1. Patient Information: Patient's full name, NRIC/FIN, date of birth, contact details

2. Healthcare Provider Details: Name and details of the healthcare institution releasing records

3. Scope of Release: Specific medical records to be released, date range

4. Purpose of Disclosure: Stated reason for requesting medical records

5. Authorization Statement: Express consent for release of specified records

6. Duration of Authorization: Validity period of the authorization

7. Signature Section: Patient/authorized representative signature and date

Optional Sections

1. Third Party Recipient: Details of authorized recipient if not the patient, use when records are to be sent to another provider

2. Witness Section: Witness details and signature, use for vulnerable patients or complex cases

3. Prohibition of Re-disclosure: Statement restricting further sharing, use for sensitive information

Suggested Schedules

1. List of Specific Records: Detailed inventory of requested records

2. Proof of Identity: Copies of identification documents

3. Legal Authorization Documents: Power of attorney or court orders if applicable

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
Information Technology

Relevant Roles

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

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Let's create your Medical Records Release Form

Authors

Alex Denne

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