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Release Of Medical Records To Family Members Form
"I need a Release Of Medical Records To Family Members Form to allow my sister access to my elderly mother's medical records from January 2025 onwards, as she will be her primary caregiver and needs to coordinate with multiple healthcare providers."
1. Patient Information: Full name, date of birth, NHS number, address, and contact details of the patient
2. Authorized Family Member Details: Full name, relationship to patient, contact details of the family member requesting access
3. Scope of Authorization: Specific medical records being authorized for release, including date ranges if applicable
4. Duration of Authorization: Time period for which the authorization remains valid
5. Declaration and Signature: Patient's confirmation and signature, or authorized representative's signature if patient lacks capacity
1. Third Party Information Exclusion: Section addressing handling of third-party information within medical records, used when records might contain information about other individuals
2. Mental Capacity Statement: Used when patient lacks capacity, including details of the person authorized to act on their behalf
3. Deceased Patient Information: Used for accessing records of deceased patients, including proof of executor status or relationship
1. Identity Verification Documents: List of acceptable ID documents and copies of provided identification
2. Proof of Authority: Documentation proving authority to act (e.g., Power of Attorney, Court Order)
3. Record Request Details: Detailed list of specific records being requested
Authors
Personal Data
Health Data
Authorized Family Member
Confidential Information
Healthcare Provider
Patient
Consent
Special Category Data
Data Subject
Data Controller
Processing
Access Rights
Permitted Purpose
Duration of Authorization
Legal Representative
Mental Capacity
Next of Kin
Third Party Information
Identity Verification
NHS Number
Power of Attorney
Data Protection Legislation
Lawful Basis
Explicit Consent
Data Protection
Confidentiality
Access Rights
Duration and Expiry
Scope of Access
Identity Verification
Information Handling
Third Party Rights
Mental Capacity
Revocation Rights
Record Types
Emergency Access
Privacy Notice
Consent Withdrawal
Information Security
Liability
Records Delivery
Deceased Patient Provisions
Capacity Assessment
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