Patient Media Release Form Template for England and Wales

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Key Requirements PROMPT example:

Patient Media Release Form

"I need a Patient Media Release Form for our teaching hospital that will allow us to use patient photos and videos for both educational purposes and marketing materials, with specific provisions for international usage across our global medical education network."

Document background

The Patient Media Release Form is essential for healthcare providers in England and Wales who need to capture and use patient media for various purposes, including treatment documentation, education, research, or marketing. This document ensures compliance with UK GDPR, the Data Protection Act 2018, and medical confidentiality requirements. It provides clear documentation of informed consent, specifies permitted uses of media, and outlines the patient's rights regarding their media. The form is particularly crucial in maintaining legal compliance while allowing healthcare providers to effectively use patient media for legitimate purposes.

Suggested Sections

1. Patient Information: Basic details including name, contact information, and patient ID

2. Purpose of Release: Clear explanation of how the media will be used

3. Scope of Consent: Specific details about what media is covered and permitted uses

4. Duration of Consent: Time period for which the consent remains valid

5. Rights and Revocation: Patient's rights including right to withdraw consent

6. Signatures: Space for patient/guardian and healthcare provider signatures

Optional Sections

1. Guardian Consent: Required section when patient is a minor or lacks capacity

2. Commercial Usage: Additional terms for commercial use of media

3. International Usage: Terms for using media outside the UK

Suggested Schedules

1. Media Description Schedule: Detailed list of specific media items covered by the release

2. Usage Guidelines: Specific guidelines for how media can and cannot be used

3. Privacy Notice: Detailed information about data protection rights and procedures

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

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Authors

Alex Denne

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