Medical Records Release Authorization Form Template for Singapore

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Key Requirements PROMPT example:

Medical Records Release Authorization Form

"I need a Medical Records Release Authorization Form for Singapore that allows my specialist at Mount Elizabeth Hospital to share my cardiology records with a research institution in Australia for a clinical trial starting in March 2025."

Document background

The Medical Records Release Authorization Form is essential in Singapore's healthcare system for managing the confidential transfer of patient medical information. This document is required whenever a patient or their legal representative needs to authorize the release of medical records to third parties, such as other healthcare providers, insurance companies, or legal representatives. It ensures compliance with Singapore's strict data protection laws, including the PDPA and HCSA, while protecting patient privacy rights. The form includes comprehensive details about the scope of information to be released, timeframes, and specific use permissions.

Suggested Sections

1. Patient Information: Full name, NRIC/passport number, date of birth, contact details of the patient authorizing release

2. Healthcare Provider Information: Name, address, and contact details of the healthcare facility/provider holding the medical records

3. Scope of Authorization: Detailed specification of which medical records are being authorized for release, including date ranges and types of records

4. Recipient Information: Details of person, healthcare provider, or entity authorized to receive the medical records

5. Duration of Authorization: Specific time period for which this authorization remains valid

6. Patient Rights Statement: Comprehensive statement of patient's rights regarding their medical information and this authorization

Optional Sections

1. Legal Representative Authorization: Section for details and authorization when someone other than the patient is making the request

2. Specific Exclusions: Section detailing any specific medical records or information that should NOT be released

3. Emergency Contact: Section for alternative contact person details in case of emergency or inability to reach the patient

Suggested Schedules

1. Schedule A - List of Requested Records: Detailed inventory of specific medical records being requested for release

2. Schedule B - Identity Documents: Copies of required identification documents of patient and/or requestor

3. Schedule C - Legal Documentation: Supporting legal documents for representatives, including power of attorney or court orders if applicable

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

Authorization Period
Authorized Representative
Confidential Information
Healthcare Provider
Medical Records
Patient
Personal Data
Protected Health Information
Recipient
Release
Requesting Party
Sensitive Personal Data
Third Party Recipients
Treatment Information
Valid Identification Document

Clauses

Authorization Grant
Confidentiality
Consent
Data Protection
Duration and Expiry
Information Scope
Patient Rights
Purpose of Disclosure
Record Handling
Recipient Obligations
Revocation Rights
Third Party Disclosure
Use Limitations
Verification and Authentication
Withdrawal of Consent

Relevant Industries

Healthcare
Insurance
Legal Services
Research Institutions

Relevant Teams

Medical Records
Compliance
Legal
Administration
Data Protection

Relevant Roles

Medical Records Officer
Healthcare Administrator
Compliance Officer
Data Protection Officer
Medical Secretary

How Genie AI reduced drafting time by 75% for a legal firm

Let's create your Medical Records Release Authorization Form

Authors

Alex Denne

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