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Protected Health Information Form
1. Data Controller Information: Identity and contact details of the healthcare provider/organization collecting the data, including DPO contact information
2. Purpose of Data Collection: Clear explanation of why the health information is being collected and how it will be used
3. Categories of Personal Data: Detailed list of the types of health and personal information being collected
4. Legal Basis: Legal grounds for processing health data under GDPR Article 9 and Danish law
5. Data Recipients: Information about who will have access to the health data and under what circumstances
6. Data Retention: How long the health information will be stored and criteria for determining retention periods
7. Data Subject Rights: Explanation of patient rights under GDPR and Danish law, including access, rectification, and deletion rights
8. Security Measures: Overview of measures taken to protect the health information
9. Consent Declaration: Clear, specific consent statements with separate signature lines for different processing activities
1. International Transfers: Include when health data may be transferred outside Denmark/EU, explaining safeguards and legal basis
2. Research Purposes: Include when data may be used for medical research, explaining specific conditions and additional rights
3. Emergency Contact Authorization: Include when allowing designation of persons who can access information in emergencies
4. Digital Health Services: Include when electronic health records or digital health services are involved
5. Special Processing Activities: Include when automated decision-making or profiling is used in healthcare context
1. Schedule A - Detailed Data Categories: Comprehensive list of all types of health data collected, including specific medical categories
2. Schedule B - Security Protocols: Detailed description of technical and organizational security measures
3. Schedule C - Third Party Recipients: List of specific third parties who may receive the data (e.g., laboratories, specialists, researchers)
4. Appendix 1 - Patient Rights Guide: Detailed explanation of all patient rights and how to exercise them
5. Appendix 2 - Privacy Notice: Supplementary detailed privacy notice as required by GDPR Article 13/14
Authors
Special Categories of Personal Data
Health Data
Processing
Data Controller
Data Processor
Data Subject
Consent
Data Protection Officer
Healthcare Provider
Medical Record
Protected Health Information
Third Party
Recipient
Data Breach
Pseudonymization
Cross-border Processing
Danish Health Authority
Healthcare Professional
Treatment
Electronic Health Record
Patient Journal
Data Retention Period
Supervisory Authority
Danish Patient Safety Database
Research Purpose
Emergency Contact
Authorized Representative
Healthcare Services
Secondary Use
Data Minimization
Data Transfer
Security Measures
Patient Rights
Lawful Basis
Danish Healthcare System
Consent
Information Collection
Data Processing
Patient Rights
Confidentiality
Data Security
Data Sharing
Data Retention
Cross-border Transfers
Breach Notification
Access Control
Emergency Procedures
Research Use
Third Party Access
Electronic Records
Data Subject Rights
Healthcare Provider Obligations
Withdrawal of Consent
Record Keeping
Information Security
Compliance
Liability
Amendments
Termination
Governing Law
Dispute Resolution
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