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Consent To Release Information Form Psychology
"I need a Consent To Release Information Form Psychology for my Singapore-based psychological practice that allows sharing client information with both local hospitals and overseas research institutions, with specific provisions for electronic data transfer and a consent period of 24 months starting March 2025."
1. Client Information: Basic identifying information of the client/patient including name, identification number, contact details and relevant demographic information
2. Provider Information: Details of the psychological service provider including name, registration number, practice details and contact information
3. Information to be Released: Specific description of what psychological information will be shared, including type of records, date range, and format
4. Purpose of Release: Clear statement of why the information is being released and how it will be used by the recipient
5. Recipients of Information: Detailed identification of who will receive the information, including organization name, contact person, and contact details
6. Duration of Consent: Specification of how long the consent remains valid and expiration date if applicable
7. Rights Statement: Comprehensive outline of client's rights regarding the consent, including right to revoke and limitations
1. Electronic Communication Consent: Additional consent provisions for electronic transmission of information, including specific platforms and security measures
2. Cross-border Transfer: Specific consent provisions for international data transfer in compliance with PDPA requirements
3. Research Use: Additional consent provisions for use of information in research purposes, including anonymization procedures
1. Specific Records List: Detailed inventory of specific psychological records to be released, including dates and types of documentation
2. Rights and Responsibilities: Comprehensive explanation of client rights and provider responsibilities under Singapore law
3. Privacy Policy: Organization's detailed privacy policy and data protection measures in compliance with PDPA
Authors
Psychological Information
Personal Data
Consent
Information Recipient
Healthcare Provider
Psychological Services
Treatment Records
Clinical Notes
Confidential Information
Disclosure
Authorization Period
Data Controller
Data Processor
Mental Health Records
Professional Relationship
Clinical Assessment
Diagnostic Information
Treatment Summary
Revocation
Legal Representative
Third Party
Electronic Transmission
Authorized Personnel
Data Protection Officer
Cross-border Transfer
Scope of Information
Duration of Consent
Rights and Responsibilities
Confidentiality
Data Protection
Electronic Communication
Information Recipients
Purpose of Disclosure
Revocation Rights
Privacy Protection
Information Storage
Data Security
Cross-border Transfer
Third Party Access
Redisclosure Limitations
Liability
Governing Law
Professional Ethics
Record Keeping
Emergency Disclosure
Research Use
Information Accuracy
Withdrawal of Consent
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