General Medical Record Release Form Template for England and Wales

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Key Requirements PROMPT example:

General Medical Record Release Form

"I need a General Medical Record Release Form that allows my elderly mother's complete medical history to be transferred from London Bridge Hospital to her new care home in Cardiff, with specific provisions for ongoing access by both her primary physician and the care home's medical staff through January 2025."

Document background
The General Medical Record Release Form serves as a crucial document in healthcare information management within England and Wales. It is used when patients or their authorized representatives need to transfer medical records to specified recipients, such as other healthcare providers, insurance companies, or legal representatives. The form ensures compliance with the Data Protection Act 2018, UK GDPR, and medical confidentiality requirements. It includes detailed patient information, specific consent declarations, scope of information to be released, and temporal validity of the authorization.
Suggested Sections

1. Patient Information: Full name, date of birth, address, contact details, NHS number

2. Healthcare Provider Details: Name and address of the healthcare provider releasing the records

3. Scope of Release: Specific records being requested, date range, type of information

4. Recipient Information: Details of person/organization receiving the records

5. Consent Declaration: Express consent statement and GDPR compliance acknowledgment

6. Expiration: Duration for which the authorization remains valid

Optional Sections

1. Third Party Authorization: Used when someone other than patient is authorized to request records

2. Specific Exclusions: When certain parts of the medical record are to be explicitly excluded

3. Emergency Contact: Additional contact person for urgent queries about the release

Suggested Schedules

1. Identity Verification Documents: Copies of required ID documents

2. Proof of Authority: For third party requests, documentation proving authority to act

3. Fee Schedule: If applicable, breakdown of any charges for record provision

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

Industries

Data Protection Act 2018: UK's primary data protection legislation that implements UK GDPR requirements, regulates processing of personal data including medical information, and establishes data subject rights and consent requirements

UK General Data Protection Regulation: Establishes core principles for processing personal data, defines special category data (including health data), and sets requirements for explicit consent

Access to Health Records Act 1990: Governs access to deceased patients' medical records and specifies who can access records and under what circumstances

Mental Capacity Act 2005: Provides framework for making decisions on behalf of people who lack capacity to consent, including provisions for representatives acting on behalf of patients

Common Law Duty of Confidentiality: Legal principle establishing that medical information remains confidential even after death and requires valid consent for disclosure

Professional Guidelines: Includes General Medical Council (GMC) guidance on confidentiality, NHS guidelines on information sharing, and British Medical Association (BMA) guidance

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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