Medical Release Form Template for Singapore

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Key Requirements PROMPT example:

Medical Release Form

"I need a Medical Release Form for our Singapore hospital that allows sharing patient records with medical researchers at multiple institutions, with specific provisions for data anonymization and a validity period from March 2025 to December 2025."

Document background

The Medical Release Form is a critical document in Singapore's healthcare ecosystem, designed to facilitate the authorized sharing of medical information while protecting patient privacy rights. It serves as a formal authorization mechanism, complying with Singapore's stringent healthcare data protection requirements under the PDPA and Healthcare Services Act. This document is essential when medical information needs to be shared between healthcare providers, insurance companies, or other authorized parties. The form typically includes specific details about the information being released, the purpose of the release, the duration of authorization, and clear identification of all parties involved.

Suggested Sections

1. Patient Information: Complete identification and contact details of the patient including NRIC/FIN, contact information, and address

2. Healthcare Provider Information: Details of the medical facility, treating physicians, and relevant license numbers

3. Scope of Release: Specific medical information being authorized for release, including types of records and date ranges

4. Purpose of Release: Clearly stated purpose for which the medical information is being released and how it will be used

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

6. Rights and Revocation: Statement of patient rights and procedure for revoking the authorization

7. Signature Block: Authentication section including patient/guardian signature, date, and witness details

Optional Sections

1. Third Party Authorization: Additional authorization details when information needs to be released to specific third parties like insurance companies or other healthcare providers

2. Guardian Authorization: Special authorization section for cases involving minors under 21 or patients lacking mental capacity

3. Specific Exclusions: Section detailing any specific medical information that is explicitly excluded from the release authorization

4. Translation Declaration: Required when the form needs to be provided in multiple languages for non-English speaking patients

Suggested Schedules

1. Schedule A - List of Authorized Recipients: Detailed list of all individuals or organizations authorized to receive the medical information

2. Schedule B - Records Checklist: Itemized checklist of specific medical records and information being authorized for release

3. Schedule C - Patient Rights Information: Comprehensive information about patient rights regarding medical records under Singapore law

4. Schedule D - Fee Schedule: Schedule of any applicable fees for medical record copies and processing

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

Relevant Industries

Healthcare
Insurance
Legal Services
Research Institutions

Relevant Teams

Medical Records
Legal
Compliance
Administrative
Patient Services

Relevant Roles

Medical Records Officer
Healthcare Administrator
Compliance Officer
Privacy Officer
Clinical Director

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Let's create your Medical Release Form

Authors

Alex Denne

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