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Authorisation For Release Of Protected Health Information Phi Template for England and Wales

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Key Requirements PROMPT example:

Authorisation For Release Of Protected Health Information Phi

"I need an Authorisation For Release Of Protected Health Information PHI that allows my specialist at London Bridge Hospital to share my complete medical history with a research team at Oxford University for a clinical trial starting in March 2025, with the authorization valid for 12 months."

Document background
The Authorisation For Release Of Protected Health Information PHI is a crucial document in England and Wales healthcare settings where patient confidentiality must be maintained while facilitating necessary information sharing. It's required whenever protected health information needs to be shared with parties other than the direct healthcare provider, whether for continued care, legal proceedings, insurance purposes, or research. The document ensures compliance with UK data protection laws and healthcare regulations while providing clear audit trails of information sharing consent.
Suggested Sections

1. Patient Information: Full details of the patient including name, date of birth, address, and NHS number

2. Authorization Statement: Clear statement of consent for information release in accordance with UK GDPR and Data Protection Act 2018

3. Information to be Released: Specific description of what health information is authorized for release, following data minimization principles

4. Purpose of Disclosure: Stated purpose for which the information will be used, ensuring purpose limitation compliance

5. Recipient Information: Details of who is authorized to receive the information and their role

6. Duration of Authorization: Validity period of the authorization and expiry date

7. Rights and Revocation: Statement of patient's rights and how to revoke authorization

8. Signature Section: Space for patient or authorized representative signature, date, and witness if required

Optional Sections

1. Mental Capacity Declaration: Required when patient lacks capacity to consent, in accordance with Mental Capacity Act 2005

2. Specific Exclusions: List of information specifically not to be shared or disclosed

3. Third Party Authorization: Additional authorization for sharing with multiple recipients or organizations

4. Special Category Data Consent: Explicit consent for processing special category health data under UK GDPR Article 9

Suggested Schedules

1. Schedule 1 - Identity Verification Documents: Copies of documents used to verify patient identity and confirm authority to request information

2. Schedule 2 - Power of Attorney Documentation: When applicable, proof of legal authority to act on patient's behalf

3. Schedule 3 - Specific Records List: Detailed inventory of specific records to be released, including date ranges and types of information

4. Schedule 4 - Privacy Notice: Information about how the released data will be processed and protected by the recipient

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

UK GDPR: The UK General Data Protection Regulation sets out the fundamental principles for processing personal data, including special category health data, with enhanced protection requirements

Data Protection Act 2018: The UK's primary data protection legislation that works alongside UK GDPR, providing specific provisions for processing health data and other special category data

Access to Health Records Act 1990: Governs the right of access to health records, particularly relevant for deceased patients' records as these fall outside GDPR scope

Mental Capacity Act 2005: Provides framework for making decisions on behalf of individuals who lack capacity, including decisions about their health information

Health and Social Care Act 2012: Sets out the framework for health and social care in England, including provisions for information governance and data sharing

Common Law Duty of Confidentiality: Legal obligation requiring health professionals to maintain confidentiality of patient information obtained in a professional capacity

Caldicott Principles: Seven principles governing how NHS and social care organizations should handle and protect patient information

NHS Act 2006: Provides legal framework for NHS services including provisions related to confidentiality and information sharing

GMC Guidance on Confidentiality: Professional guidelines from the General Medical Council on handling patient information and maintaining confidentiality

BMA Guidance: British Medical Association's professional guidance on medical ethics and confidentiality including information sharing

NHS Digital Guidelines: Specific technical and operational guidelines for handling health information within NHS digital systems

ICO Health Data Guidance: Information Commissioner's Office specific guidance on processing health data under UK data protection laws

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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