Authorization To Release Information To Family Members Template for United Arab Emirates

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Key Requirements PROMPT example:

Authorization To Release Information To Family Members

"I need an Authorization To Release Information To Family Members document that allows my spouse and adult children to access my complete medical records from January 2025 to December 2025, while I undergo cancer treatment at Dubai Healthcare City."

Document background

The Authorization To Release Information To Family Members is essential in UAE healthcare settings where family involvement in patient care is both culturally significant and legally regulated. This document becomes necessary when patients wish to allow family members access to their medical information while maintaining control over what information is shared and with whom. It must comply with UAE Federal Laws, including Law No. 45 of 2021 on Protection of Personal Data and healthcare-specific regulations. The authorization helps healthcare providers maintain patient privacy while legally sharing information with authorized family members. It's particularly relevant in situations involving ongoing medical care, chronic conditions, or when patients need family support in managing their healthcare.

Suggested Sections

1. Patient Information: Full legal name, Emirates ID number, date of birth, and contact information of the patient giving authorization

2. Authorized Family Members: Detailed information about family members being authorized, including full names, Emirates ID numbers, and relationship to patient

3. Scope of Authorization: Specific types of information that may be released (e.g., medical records, test results, billing information)

4. Duration of Authorization: Time period for which the authorization is valid, including start date and expiration date

5. Authorization Statement: Clear statement of patient's consent to release information, including reference to relevant UAE laws

6. Revocation Rights: Statement explaining the patient's right to revoke the authorization and the process for doing so

7. Signature Block: Space for patient's signature, date, and witness signature if required

Optional Sections

1. Emergency Contact Designation: Optional section to specifically designate one or more authorized family members as emergency contacts

2. Information Access Limitations: Additional restrictions or specific exclusions for certain types of information or circumstances

3. Digital Communication Consent: Optional authorization for sharing information through digital means (email, patient portals, etc.)

4. Language Preference: For multi-lingual families, specification of preferred language for communication

5. Healthcare Provider List: Specific list of healthcare providers or facilities where this authorization applies

Suggested Schedules

1. Schedule A - Authorized Information Types: Detailed checklist of specific types of medical information that can be released

2. Schedule B - Authorized Family Members Details: Detailed information about each authorized family member, including copies of Emirates ID

3. Schedule C - Specific Restrictions: Detailed list of any specific restrictions or special instructions regarding information sharing

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 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

Authorized Family Member
Confidential Information
Emirates ID
Family Member
Healthcare Provider
Health Information
Medical Facility
Medical Records
Patient
Personal Data
Protected Health Information
Release Authorization
Revocation Notice
Sensitive Information
Treatment Information

Clauses

Authorization Grant
Consent
Data Protection
Duration and Expiry
Family Member Identification
Information Access
Information Scope
Patient Rights
Privacy Protection
Record Handling
Revocation Rights
Signature and Witnessing
Verification Procedures

Relevant Industries

Healthcare

Medical Services

Hospital Administration

Clinical Services

Mental Health Services

Rehabilitation Services

Long-term Care

Emergency Medical Services

Outpatient Services

Insurance

Relevant Teams

Legal

Compliance

Medical Records

Patient Relations

Risk Management

Information Security

Patient Services

Clinical Administration

Privacy Office

Relevant Roles

Medical Director

Healthcare Administrator

Compliance Officer

Medical Records Manager

Patient Relations Manager

Privacy Officer

Healthcare Provider

Physician

Nurse Manager

Legal Counsel

Risk Management Officer

Information Security Officer

Patient Services Coordinator

Clinical Administrator

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