Disability Medical Release Form Template for England and Wales

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Key Requirements PROMPT example:

Disability Medical Release Form

"I need a Disability Medical Release Form that allows my employer and occupational health provider to access my medical records related to my mobility condition for the next 12 months, starting from January 2025, to arrange workplace accommodations."

Document background
The Disability Medical Release Form is essential when an individual needs to share their disability-related medical information with specific parties while maintaining legal compliance in England and Wales. This document is commonly required for disability benefit claims, workplace accommodations, educational support, or insurance purposes. It ensures compliance with UK data protection laws and medical confidentiality requirements while providing a clear framework for authorized information sharing. The form includes specific details about what information can be shared, with whom, and for how long, while protecting the individual's privacy rights and ensuring proper handling of sensitive medical data.
Suggested Sections

1. Individual's Personal Information: Basic details including name, date of birth, address, and contact information

2. Medical Information Authorization: Specific authorization for release of medical information including scope and duration

3. Purpose of Release: Clear statement of why the medical information is being released

4. Recipients of Information: Details of who is authorized to receive the medical information

5. Data Protection Statement: Information about how data will be handled and protected

6. Signature Section: Space for signatures, dates, and witness information

Optional Sections

1. Representative Authorization: Used when someone else is authorized to act on behalf of the individual - applicable when individual lacks capacity or chooses to delegate authority

2. Specific Exclusions: Details of any medical information specifically excluded from the release - used when individual wants to restrict certain information from being shared

3. Time Limitations: Specific time periods for which the release is valid - used when release should be limited to specific time period

Suggested Schedules

1. Schedule A - Detailed Medical Records List: Itemized list of specific medical records to be released

2. Schedule B - Authorized Recipients: Detailed list of all authorized recipients and their contact information

3. Appendix 1 - Privacy Notice: Detailed privacy notice explaining data protection rights and procedures

4. Appendix 2 - Capacity Assessment: If relevant, documentation of capacity assessment

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

Relevant Industries
Relevant Teams
Relevant Roles
Industries

Data Protection Act 2018 and UK GDPR: Primary legislation governing personal and sensitive medical data handling, including requirements for explicit consent, data subject rights, and data security requirements

Equality Act 2010: Defines disability as a protected characteristic and ensures non-discrimination in handling medical information, including requirements for reasonable adjustments

Access to Medical Reports Act 1988: Governs rights regarding access to medical reports, consent requirements for medical information disclosure, and establishes time limits for viewing reports

Mental Capacity Act 2005: Addresses considerations for individuals who may lack capacity to consent, requirements for representatives/attorneys, and best interests decision-making

Human Rights Act 1998: Ensures fundamental rights including right to privacy, right to non-discrimination, and right to dignity in medical contexts

Common Law Duty of Confidentiality: Establishes medical confidentiality obligations and circumstances where disclosure of medical information is permitted

NHS Act 2006: Contains relevant provisions regarding medical information sharing and healthcare provider obligations in the National Health Service context

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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