Info Release Form Template for Canada

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Key Requirements PROMPT example:

Info Release Form

"I need an Info Release Form for my medical clinic to share patient records with specialist consultants, ensuring PIPEDA compliance and including specific provisions for electronic transmission of diagnostic images, effective from March 2025."

Document background

The Info Release Form serves as a critical document in Canadian business and institutional operations, ensuring compliance with privacy laws while facilitating necessary information sharing. This document is essential when personal, medical, financial, or other confidential information needs to be shared between authorized parties. It's designed to meet requirements under Canadian federal privacy legislation (PIPEDA) and applicable provincial privacy laws, providing clear documentation of consent and specific parameters for information sharing. The form is commonly used in healthcare settings, financial institutions, educational institutions, and various business contexts where protected information must be shared with authorized third parties. It includes specific provisions for consent, scope of release, duration, and the right to revoke authorization.

Suggested Sections

1. Identification of Parties: Details of the information provider (subject) and the organization/entity requesting the information, including full legal names and contact information

2. Purpose of Release: Clear statement of why the information is being requested and how it will be used

3. Information to be Released: Specific description of what information is authorized for release, including date ranges if applicable

4. Duration of Authorization: Time period for which the release authorization is valid, including start and end dates

5. Recipient Information: Details of who is authorized to receive the information

6. Rights and Revocation: Statement of the subject's rights, including the right to revoke authorization and the process for doing so

7. Privacy Notice: Statement about how the information will be protected and handled in accordance with privacy laws

8. Signature and Date: Space for signatures of all required parties and dates of signing

Optional Sections

1. Sensitive Information Authorization: Additional explicit consent for release of sensitive information such as medical records, financial data, or other protected information

2. Third Party Authorization: Section authorizing release of information to specific third parties beyond the primary recipient

3. Electronic Distribution Authorization: Specific permission for electronic transmission of information and associated security measures

4. Minor/Dependent Authorization: Additional section when the subject is a minor or dependent, requiring guardian authorization

5. Re-disclosure Provisions: Terms regarding whether and how information can be shared by the recipient with other parties

Suggested Schedules

1. Schedule A - Detailed Information List: Comprehensive list of specific information items authorized for release

2. Schedule B - Authorized Recipients: List of all authorized recipients and their contact information when multiple parties are involved

3. Schedule C - Security Protocols: Detailed security measures and protocols for handling the released information

4. Appendix 1 - Consent Withdrawal Form: Template form for withdrawing consent for information release

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

Financial Services

Education

Insurance

Legal Services

Human Resources

Government Services

Social Services

Research Institutions

Professional Services

Real Estate

Telecommunications

Relevant Teams

Legal

Compliance

Privacy

Human Resources

Information Security

Risk Management

Records Management

Customer Service

Operations

Administrative Services

Information Technology

Data Management

Relevant Roles

Privacy Officer

Compliance Manager

Legal Counsel

Human Resources Manager

Medical Records Administrator

Information Security Officer

Risk Manager

Data Protection Officer

Records Manager

Healthcare Administrator

Financial Advisor

Educational Administrator

Customer Service Manager

Operations Director

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Authors

Alex Denne

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