Patient Information Release Form Template for Hong Kong

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Key Requirements PROMPT example:

Patient Information Release Form

"I need a Patient Information Release Form for our hospital group that's compliant with Hong Kong regulations, includes electronic health record sharing provisions, and will be implemented across our five locations starting January 2025."

Document background

The Patient Information Release Form serves as a critical document in Hong Kong's healthcare system, enabling the authorized sharing of medical information while maintaining patient privacy and confidentiality. This form is essential when patients need their medical records shared between healthcare providers, insurance companies, or other authorized parties. It must comply with the Personal Data (Privacy) Ordinance and specific healthcare regulations in Hong Kong, incorporating proper consent mechanisms and clear authorization parameters. The document is designed to protect both healthcare providers and patients by clearly documenting the scope, purpose, and duration of information release, while ensuring all parties understand their rights and obligations under Hong Kong law.

Suggested Sections

1. Patient Information: Full identification details of the patient including name, ID number, date of birth, contact information, and medical record number

2. Healthcare Provider Details: Information about the healthcare facility/provider releasing the information, including name, address, and contact details

3. Information to be Released: Specific description of medical information authorized for release, including date ranges and types of records

4. Recipient Authorization: Details of the person or organization authorized to receive the information, including their relationship to the patient

5. Purpose of Disclosure: Clear statement of the reason for releasing the medical information

6. Duration of Authorization: Specification of how long the authorization remains valid

7. Patient Rights Statement: Statement of patient's rights regarding the release of information, including right to revoke authorization

8. Signatures: Space for patient or authorized representative signature, date, and witness if required

Optional Sections

1. Special Categories of Information: Additional authorization sections for sensitive information such as mental health records, HIV status, or substance abuse treatment - used when such records may be included

2. Emergency Contact Authorization: Section for authorizing information release to emergency contacts - included when patient wants to pre-authorize emergency disclosures

3. Electronic Release Authorization: Specific consent for electronic transmission of records - included when digital transfer methods may be used

4. Third Party Payment Authorization: Authorization for release of information to insurance companies or other payers - included when payment/reimbursement is involved

Suggested Schedules

1. Schedule A - Types of Medical Records: Detailed checklist of different types of medical records that can be released (e.g., consultation notes, test results, imaging reports)

2. Schedule B - Authorized Recipients List: List of pre-authorized recipients and their access levels, if multiple parties are involved

3. Appendix 1 - Privacy Policy Summary: Summary of relevant privacy policies and patient rights under Hong Kong law

4. Appendix 2 - Revocation Form: Form for revoking the authorization if patient wishes to cancel it

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

Relevant legal definitions

Clauses

Patient Identification
Authorization
Consent
Information Scope
Data Privacy
Confidentiality
Duration
Rights and Obligations
Revocation
Liability
Emergency Provisions
Electronic Records
Data Security
Third Party Access
Purpose Limitation
Signatures and Attestation

Relevant Industries

Healthcare

Insurance

Medical Research

Pharmaceuticals

Elder Care

Mental Health Services

Public Health

Healthcare Technology

Legal Services

Education (Medical Institutions)

Relevant Teams

Medical Records

Compliance

Legal

Patient Services

Information Security

Risk Management

Quality Assurance

Operations

Clinical Administration

Data Protection

Relevant Roles

Medical Records Officer

Privacy Officer

Healthcare Administrator

Medical Director

Compliance Manager

Data Protection Officer

Clinical Director

Patient Services Manager

Medical Secretary

Legal Counsel

Risk Management Officer

Quality Assurance Manager

Healthcare Operations Manager

Information Security Officer

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