Authorization To Disclose Health Information Form Template for Australia

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

4.6 / 5

4.8 / 5

Let's create your Authorization To Disclose Health Information 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:

Authorization To Disclose Health Information Form

"I need an Authorization to Disclose Health Information Form for a multi-specialist medical practice in Sydney, allowing ongoing sharing of patient records between primary care physicians and specialist consultants throughout 2025, with specific provisions for mental health records."

Document background

The Authorization To Disclose Health Information Form is a crucial document used in Australian healthcare settings to ensure compliance with privacy laws and protect patient rights while facilitating necessary information sharing. This form is required whenever protected health information needs to be shared between healthcare providers, organizations, or other authorized parties. It includes specific sections for patient identification, details of the information to be disclosed, recipient information, purpose of disclosure, and duration of authorization. The document must comply with the Privacy Act 1988 (Cth), relevant state health records legislation, and healthcare privacy principles. It is particularly important in cases involving ongoing care, specialist referrals, insurance claims, legal proceedings, or research purposes, where proper authorization for information sharing is essential.

Suggested Sections

1. Patient Information: Patient's full legal name, date of birth, address, contact details, and any relevant identification numbers (e.g., Medicare number)

2. Healthcare Provider Details: Information about the healthcare provider/organization authorized to release the information, including name, address, and contact details

3. Recipient Information: Details of the person or organization authorized to receive the health information, including name, address, and contact information

4. Information to be Disclosed: Specific description of the health information authorized for release, including date ranges and types of records

5. Purpose of Disclosure: Statement of the reason(s) for requesting the disclosure of health information

6. Duration of Authorization: Specification of how long the authorization remains valid, including start and end dates

7. Rights and Notifications: Statement of patient's rights regarding the authorization, including right to revoke and any limitations

8. Privacy Notice: Mandatory privacy notice as required by Australian privacy laws, including how information will be handled

9. Authorization Statement and Signature: Formal authorization statement, signature lines for patient or authorized representative, and date

Optional Sections

1. Specific Exclusions: Section to explicitly list any information that should NOT be disclosed, used when patient wants to restrict certain information

2. Third Party Authorization: Additional section when someone other than the patient is authorized to sign, including proof of authority (e.g., power of attorney, guardian)

3. Special Conditions: Any special conditions or restrictions on the use of the disclosed information, included when specific limitations are needed

4. Emergency Contact: Details of emergency contact person, included when relevant to the purpose of disclosure

5. Witness Section: Section for witness signature and details, used when required by specific healthcare provider policies or for vulnerable patients

Suggested Schedules

1. Schedule A - Types of Health Information: Detailed checklist of specific types of health information that may be disclosed (e.g., medical records, test results, medications)

2. Schedule B - Authorized Recipients List: Used when multiple recipients are authorized to receive information, listing all authorized parties and their details

3. Schedule C - Privacy Policy Summary: Summary of relevant privacy policies and procedures governing the handling of disclosed information

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 Services

Allied Health

Mental Health

Aged Care

Disability Services

Insurance

Legal Services

Government Health Services

Education (for medical training institutions)

Pharmaceutical

Research and Clinical Trials

Relevant Teams

Legal

Compliance

Medical Records

Privacy and Data Protection

Healthcare Administration

Clinical Operations

Patient Services

Risk Management

Quality Assurance

Information Management

Relevant Roles

Healthcare Administrator

Medical Records Manager

Privacy Officer

Compliance Manager

Medical Practice Manager

Healthcare Provider

Legal Counsel

Data Protection Officer

Clinical Director

Records Coordinator

Practice Nurse

General Practitioner

Specialist Physician

Allied Health Professional

Healthcare Reception Manager

Find the exact document you need

Release Form For Towed Car

An Australian-compliant legal release form documenting the return of a towed vehicle to its owner and release of liability between parties.

How Genie AI reduced drafting time by 75% for a legal firm

Let's create your Authorization To Disclose Health Information Form

Authors

Alex Denne

Find the exact document you need

Release Form For Towed Car

Records Release Request Form

General Release Of Medical Information Form

Employment Verification Authorization Release Form

Authorization To Release Employment Information

Authorization To Release Documents

Legal Medical Consent Form

Medical Release Waiver

Counseling Release Form

Release Of Medical Records To Patient Form

Generic Medical Release Form

X Ray Release Form

Workers Compensation Authorization For Release Of Medical Records

Tenant Consent To Release Information Form

Student Release Form

Release Form For Towing Company

Promissory Note Release

Patient Disclosure Authorization Form

Minor Release Form

Medication Release Form

Medical Record Request Letter

Inmate Release Form

General Authorization For Release Of Information

Form Medical Record

Fitness Liability Waiver Form

Estate Executor Release Form

Employee Driving Record Release Form

Consent To Disclose Personal Health Information Form

Image Consent Form

Babysitting Release Form

Authorization To Share Information

Authorization To Release Medical Information To Family Members

Medical Photo Consent Form

Authorization To Disclose Information Form

Audio Release Form

Legal Photo Release Form

Release Form For Hair Services

Legal Release Document

Basic Medical Release Form

Psychologist Release Of Information Form

Video Recording Consent Form

Medical Treatment Authorization And Consent Form

Therapy Release Of Information

Release Of Information Form Mental Health

Travel Release Form For Minor

Pet Sitting Release Form

Medical Information Consent Form

Authorization To Release Personal Information

Temporary Guardianship Medical Consent Form

Key Release Form

Data Release Form

Authorization To Disclose Health Information Form

Hospital Discharge Form

Medical Records Form

Participation Waiver Form

Babysitter Medical Consent Form

Standard Medical Consent Form

Release Request Form

Printing Release Form

Pre Employment Background Check Consent Form

New Release Form

Minor Consent To Treat Form

Medical Records Authorization Form

Injury Release Form

Individual Release Form

Employee Key Release Form

Vehicle Property Release Form

Simple Release Form

Risk Waiver Form

Release Of Medical Records To Family Members Form

Release Of Information Form For Rental History

Protected Health Information Form

Permission To Use Photo Agreement

Parent Medical Consent Form

Mental Health Records Release Form