Patient Information Release Form Template for United Arab Emirates

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Patient Information Release Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Patient Information Release Form

"I need a Patient Information Release Form for a Dubai-based private hospital that allows for the sharing of pediatric medical records with multiple healthcare providers, including provisions for guardian consent and specific restrictions on sharing genetic testing results."

Document background

The Patient Information Release Form is an essential document used in UAE healthcare settings when there is a need to share patient medical information with authorized parties. This form is required under UAE Federal Law No. 2 of 2019 and related healthcare regulations whenever patient information needs to be disclosed to third parties, transferred between healthcare providers, or released for specific purposes such as insurance claims or legal proceedings. The document ensures proper documentation of consent, protects patient privacy rights, and establishes clear parameters for information sharing. It includes crucial details such as patient identification, scope of information to be released, duration of authorization, and intended recipients. Healthcare providers in the UAE must maintain these forms as part of their legal compliance and medical records management system.

Suggested Sections

1. Patient Information: Basic details of the patient including full name, Emirates ID, date of birth, contact information, and medical record number

2. Requesting Party Details: Information about the person/entity requesting access to the medical records, including their relationship to the patient if not the patient themselves

3. Information to be Released: Specific description of medical information authorized for release, including date ranges and types of records

4. Purpose of Release: Clear statement of the reason for requesting the medical information

5. Duration of Authorization: Validity period of the authorization and expiry date

6. Release Method: Specification of how the information will be transmitted or accessed

7. Patient Rights Statement: Statement of patient's rights regarding the release of information, including right to revoke authorization

8. Confidentiality Statement: Statement regarding the confidential handling of released information and restrictions on further disclosure

9. Signatures and Attestation: Space for required signatures, including patient/guardian, witness, and healthcare provider representative

Optional Sections

1. Guardian Authorization: Additional section for cases where the patient is a minor or legally incapacitated

2. Specific Exclusions: Section to explicitly state any information that should NOT be released

3. Emergency Contact: Optional inclusion of emergency contact information

4. Fee Schedule: Information about any applicable fees for record retrieval and copying, if relevant

5. Third Party Authorization: Additional authorization details when information is to be released to third parties other than the requesting party

Suggested Schedules

1. Schedule A - Types of Medical Records: Detailed checklist of different types of medical records that can be released (e.g., lab results, imaging reports, consultation notes)

2. Schedule B - Authorized Recipients List: List of specific individuals or entities authorized to receive the information, if multiple recipients are involved

3. Appendix 1 - Identity Verification Requirements: Documentation requirements for verifying the identity of the requesting party

4. Appendix 2 - Privacy Policy Summary: Summary of relevant privacy policies and patient rights under UAE law

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

Clauses

Relevant Industries

Healthcare

Medical Insurance

Legal Services

Healthcare Administration

Medical Research

Pharmaceutical

Education (Medical Institutions)

Government Health Authorities

Healthcare Technology

Medical Records Management

Relevant Teams

Medical Records

Legal

Compliance

Patient Relations

Health Information Management

Quality Assurance

Risk Management

Clinical Administration

Data Protection

Operations

Relevant Roles

Medical Records Officer

Privacy Officer

Healthcare Administrator

Compliance Manager

Medical Director

Legal Counsel

Data Protection Officer

Patient Relations Manager

Clinical Documentation Specialist

Healthcare Operations Manager

Quality Assurance Manager

Risk Management Officer

Medical Secretary

Health Information Manager

Patient Care Coordinator

Find the exact document you need

Termination Of Account Letter

A UAE-compliant formal notice from a bank to an account holder announcing the termination of banking services and outlining closure procedures.

How a Sales & Marketing Lead uses Genie AI to reduce contract drafting time by 95%

Let's create your Patient Information Release Form

Authors

Alex Denne

Find the exact document you need

Termination Of Account Letter

Key Release Form

Gym Disclaimer Form

Generic Authorization To Release Information

Final Release Form

Employee Media Release Form

Driving Record Authorization Form

Release Of Information

Photography Consent Form

Background Check Consent Form

Release Of Liability

Medical Consent Form

Medical Release Form

Data Release Form

Consent To Share Medical Information Form

Consent Letter To Release Medical Information

Consent Form To Share Information

Check Release Form

Authorization To Release Confidential Information

Authorization Letter To Release Information

Standard Release Form

Consent And Release Form

Paycheck Release Form

Simple Release Form

Insurance Release Form

Patient Information Release Form

Risk Waiver Form

Authorization To Disclose Health Information Form

Nanny Medical Consent Form

Hospital Discharge Form

Authorization To Disclose Protected Health Information

Medical Waiver

Medical Records Form

Participation Waiver Form

Social Media Consent Form

Media Consent Form

Babysitter Medical Consent Form

Disclosure Of Health Information Form

Authorization Letter To Release Information

Motor Vehicle Accident Release Form

Medical Records Authorization Form

Individual Release Form

Employee Key Release Form

Protected Health Information Form

Parent Medical Consent Form

Hospital Release Form

Dental Photo Consent Form

Consent To Release Personal Information Form

Actor Release Form

Authorization Letter To Get Medical Records

General Consent To Release Information Form

Title Lien Release Letter

Tenant Information Release Form

Medical History Consent Form

Hospital Patient Release Form

Hospital Patient Discharge Form

Generic Medical Records Request Form

Consent To Disclose Personal Information Form

Clearance Release Form

Authorization Letter For Release Of Documents

Authorization To Release Information To Family Members

Financial Release Letter

Emergency Room Release Form

Consent To Share Form

Medical Records Release Letter

Statement Release Form

Medical Consent Form For Family Members

Legal Release Of Information Form

Full Duty Release Form

Check Release Form

Basic Photo Release Form

Medical Records Transfer Form

Return To Work Release Form

Sports Medical Waiver Form

Endorsement Release Form