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Protected Health Information Form
"I need a Protected Health Information Form for our new digital health startup launching in March 2025, which will collect patient data through a mobile app and share it with NHS providers in London."
1. Patient Information: Basic identifying information about the patient including name, contact details, NHS number, and relevant identifiers
2. Purpose of Information Collection: Detailed explanation of why the health information is being collected and how it will be used
3. Consent Declaration: Express consent section including statements of understanding and signature fields for the patient or authorized representative
4. Information to be Collected: Comprehensive list of health information types that will be collected and processed
5. Data Protection Rights: Clear explanation of patient rights under UK GDPR and Data Protection Act 2018, including right to access, rectification, and erasure
6. Security Measures: Overview of technical and organizational measures implemented to protect health information
1. Third Party Disclosure: Details of circumstances under which information may be shared with other healthcare providers or organizations
2. Research Use: Specific provisions and additional consent requirements for using health data in research studies
3. International Transfers: Information about potential transfers of health data outside the UK and associated safeguards
1. Schedule 1: Detailed Data Categories: Comprehensive list of all health data categories to be collected and processed
2. Schedule 2: Security Protocols: Detailed technical and organizational security measures for protecting health information
3. Schedule 3: Third Party Recipients: List of authorized third-party recipients and circumstances for sharing
4. Appendix A: Patient Rights Guide: Detailed explanation of patient data protection rights and how to exercise them
5. Appendix B: Privacy Notice: Detailed privacy notice compliant with UK GDPR Article 13/14 requirements
Authors
Personal Data
Special Category Data
Data Subject
Data Controller
Data Processor
Processing
Consent
Healthcare Provider
Medical Records
Electronic Health Records (EHR)
Health Information System
Confidential Information
Authorized Personnel
Data Protection Officer
Security Measures
Data Breach
Third Party Recipients
Cross-border Transfer
Anonymisation
Pseudonymisation
Data Minimisation
Storage Limitation
Patient Rights
Legitimate Interest
Legal Basis for Processing
Regulatory Authority
Information Commissioner's Office (ICO)
NHS Digital
Caldicott Guardian
Consent
Purpose Limitation
Data Processing
Data Security
Confidentiality
Access Rights
Data Sharing
Storage and Retention
Data Subject Rights
Data Protection
Information Use
Breach Notification
Third Party Disclosure
Cross-border Transfers
Record Management
Information Security
Compliance
Withdrawal of Consent
Data Destruction
Emergency Disclosure
Research Use
Audit Rights
Staff Training
Documentation Requirements
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