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Consent Letter For Medical Report
"I need a Consent Letter for Medical Report to authorize Singapore General Hospital to release my complete medical history from the past 5 years to my insurance company (AIA Singapore) for a critical illness claim, with the consent valid until March 2025."
1. Patient Information: Full name, NRIC/Passport number, date of birth, contact details of the patient
2. Healthcare Provider Details: Name of hospital/clinic, doctor's name, registration number and contact information
3. Purpose Statement: Clear statement of purpose for medical report request and intended use
4. Scope of Disclosure: Specific medical information to be released and any limitations on disclosure
5. Recipient Information: Details of person/organization authorized to receive the medical report
6. Duration of Validity: Period for which the consent remains valid and expiration date if applicable
1. Third Party Authorization: Authorization details when someone other than patient is permitted to collect the report
2. Special Instructions: Any specific requirements or format specifications for the medical report
3. Legal Representative Details: Information about guardian or appointed representative when patient lacks mental capacity or is a minor
1. Identity Verification Documents: Copies of NRIC/Passport of patient and/or authorized person
2. Power of Attorney Documentation: Legal documentation of representation rights where applicable
3. Previous Consent Forms: Copies of previous consent forms if this is an extension or modification
Authors
Healthcare Provider
Medical Report
Medical Records
Personal Data
Confidential Information
Protected Health Information
Authorized Recipients
Consent Period
Medical Professional
Healthcare Institution
Medical Condition
Treatment Records
Disclosure
NRIC/Identification Number
Legal Representative
Third Party
Validity Period
Medical Documentation
Purpose of Disclosure
Consent Declaration
Purpose of Disclosure
Scope of Information
Duration of Consent
Confidentiality
Data Protection
Authorization
Information Release
Third Party Access
Revocation Rights
Legal Representative Authority
Healthcare Provider Rights
Liability Limitation
Privacy Protection
Information Accuracy
Document Validity
Signature and Witnessing
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