Create a bespoke document in minutes, or upload and review your own.
Get your first 2 documents free
Your data doesn't train Genie's AI
You keep IP ownership of your information
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."
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
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
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
Protected Health Information
Personal Data
Healthcare Provider
Authorized Representative
Patient
Recipient
Consent
Release Authorization
Confidential Information
Special Category Data
Data Controller
Data Processor
Health Record
Treatment Record
Medical History
Clinical Notes
Disclosure
Data Subject
Processing
Third Party
Valid Period
Revocation
Express Consent
Capacity
Consent Authorization
Scope of Release
Duration and Expiration
Information Access Rights
Confidentiality
Data Protection
Record Transfer Method
Disclosure Limitations
Revocation Rights
Patient Rights
Healthcare Provider Obligations
Recipient Obligations
Liability
Certification
Privacy Notice
Authentication
Special Instructions
Emergency Provisions
Records Delivery
Fee Arrangements
Third Party Authorization
Governing Law
Signature Requirements
Find the exact document you need
Authorisation Of Release Of Unemployment Records Form
A legal form used in England and Wales to authorize the release of individual unemployment records in compliance with UK data protection laws.
Authorisation For Release Of Records
A legal document under English and Welsh law authorizing the release of specific records from one party to another, in compliance with UK data protection legislation.
Release Of Information Statement
A legal document under English and Welsh law authorizing and governing the release of specific information between parties while ensuring data protection compliance.
Printable Work Release Form
A legally binding document under English and Welsh law that formalizes the termination of employment and mutual release of claims between employer and employee.
Dental Release Of Information Form
A legal document under English and Welsh law authorizing the release of dental records and information to specified parties.
Work Release Form From Doctor
A medical document used in England and Wales certifying an employee's fitness to return to work, compliant with UK healthcare and employment regulations.
Universal Medical Release Form
A legal document under English and Welsh law authorizing the release of medical records to specified parties while ensuring data protection compliance.
Service Release Form
A legally binding document under English and Welsh law that releases parties from obligations and liabilities related to completed services.
Revocation Of Release Of Information Form
An English and Welsh law-compliant document for withdrawing previously granted authorization for information sharing and processing.
Release Form For Video Recording
A legal document under English and Welsh law that obtains consent for video recording and establishes usage rights for the recorded content.
Download our whitepaper on the future of AI in Legal
Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
Our bank-grade security infrastructure undergoes regular external audits
We are ISO27001 certified, so your data is secure
Organizational security
You retain IP ownership of your documents
You have full control over your data and who gets to see it
Innovation in privacy:
Genie partnered with the Computational Privacy Department at Imperial College London
Together, we ran a £1 million research project on privacy and anonymity in legal contracts
Want to know more?
Visit our Trust Centre for more details and real-time security updates.
Read our Privacy Policy.