Protected Health Information Form Template for England and Wales

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Key Requirements PROMPT example:

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."

Document background
The Protected Health Information Form serves as a crucial compliance tool in England and Wales for organizations handling sensitive medical data. It is required whenever protected health information needs to be collected, processed, or shared, ensuring compliance with UK GDPR and the Data Protection Act 2018. The form includes detailed information about data collection purposes, processing activities, security measures, and patient rights, while establishing clear consent mechanisms for handling confidential health information. It's particularly important in healthcare settings, research institutions, and any organization dealing with medical records.
Suggested Sections

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

Optional Sections

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

Suggested Schedules

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

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 legal definitions
Industries

UK Data Protection Act 2018: Primary UK legislation that controls how personal information is used and processed, complementing the UK GDPR

UK GDPR: Post-Brexit version of GDPR that sets standards for processing personal data in the UK, including special category health data

Health and Social Care Act 2012: Legislation governing the structure and function of the NHS, including provisions for health data management

Access to Health Records Act 1990: Regulates access to health records, particularly for deceased patients

Mental Capacity Act 2005: Framework for making decisions on behalf of individuals who lack capacity, including consent for data processing

Caldicott Principles: Seven principles governing the handling of patient-identifiable information in healthcare settings

NHS Data Security and Protection Toolkit: Set of standards organizations must complete to ensure they practice good data security

Common Law Duty of Confidentiality: Legal obligation to protect personal information that is shared in confidence

Professional Standards: Guidelines set by professional bodies like GMC and NMC regarding handling of patient information

Privacy and Electronic Communications Regulations: Specific rules for privacy of electronic communications, complementing data protection laws

Human Rights Act 1998: Particularly Article 8 which ensures the right to respect for private and family life

Freedom of Information Act 2000: Regulates public access to information held by public authorities, including health records

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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