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Authorisation For Disclosure Of Medical Information Template for England and Wales

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Key Requirements PROMPT example:

Authorisation For Disclosure Of Medical Information

"I need an Authorisation For Disclosure Of Medical Information to allow my insurance company to access my medical records from London Bridge Hospital for the period January 2025 to June 2025, specifically relating to my knee surgery and subsequent physiotherapy."

Document background
The Authorisation For Disclosure Of Medical Information serves as a crucial document in healthcare information management within England and Wales. It is required whenever medical information needs to be shared between healthcare providers, insurance companies, legal representatives, or other authorized parties. This authorization ensures compliance with data protection laws, including the Data Protection Act 2018 and UK GDPR, while respecting patient confidentiality. The document specifically outlines what information can be shared, with whom, and for what duration, providing clear accountability and audit trail for sensitive medical data transfers.
Suggested Sections

1. Patient Information: Full name, date of birth, address, NHS number or other relevant identifiers

2. Authorisation Statement: Clear statement of consent for disclosure

3. Scope of Disclosure: Specific information to be disclosed and time period covered

4. Recipient Details: Who is authorized to receive the information

5. Duration of Authorization: How long the authorization remains valid

6. Patient Declaration: Signature and date of authorization

Optional Sections

1. Third Party Authorization: Authorization section for when someone other than the patient is providing authorization (used when patient lacks capacity or for minors)

2. Specific Exclusions: Section detailing any specific information that should not be disclosed (used when patient wants to restrict certain information)

3. Purpose of Disclosure: Section specifying the reason for requesting information (used when disclosure is for specific purpose only)

Suggested Schedules

1. Proof of Identity: Copies of identification documents

2. Power of Attorney: If applicable, documentation proving authority to act on patient's behalf

3. Specific Records Request Form: Detailed form listing specific records being requested

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions






























Clauses

























Industries

Data Protection Act 2018: The UK's primary data protection legislation that implements national data protection standards, sets out rules for processing personal data, and specifically defines special category data including health information

UK General Data Protection Regulation (UK GDPR): Post-Brexit version of EU GDPR that establishes principles for processing personal data, defines data subject rights, and sets requirements for lawful processing of personal information

Access to Health Records Act 1990: Legislation that specifically governs access to deceased patients' medical records and defines who can legally access such records

Common Law Duty of Confidentiality: Legal principle establishing that medical information is provided in confidence and requires explicit consent for disclosure to third parties

Mental Capacity Act 2005: Legislation relevant when patients lack capacity, determining who can make decisions on behalf of others regarding medical information disclosure

Human Rights Act 1998: Legislation incorporating Article 8 (right to privacy) and establishing the balance between privacy rights and necessary disclosure of medical information

NHS Act 2006: Statutory framework for NHS services including specific information governance requirements for handling medical information

Professional Guidelines: Collection of professional standards including GMC guidance, NHS information sharing protocols, and Caldicott Principles for handling medical information

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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