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Consent To Release Information Form Psychology Template for England and Wales

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Key Requirements PROMPT example:

Consent To Release Information Form Psychology

"I need a Consent To Release Information Form Psychology that allows my therapist to share specific assessment results with my workplace occupational health team for the next 6 months, starting from January 2025, with particular emphasis on maintaining confidentiality of personal details."

Document background
The Consent To Release Information Form Psychology is a critical document used in mental health practice across England and Wales when there is a need to share psychological information with third parties. It serves as a formal authorization mechanism that protects both the client's rights and the practitioner's professional obligations. The form is designed to comply with UK data protection laws, including GDPR and the Data Protection Act 2018, while adhering to professional guidelines set by the British Psychological Society. It should be used whenever psychological information needs to be shared beyond the immediate therapeutic relationship, whether for legal proceedings, educational purposes, or coordination of care.
Suggested Sections

1. Client Information: Personal details of the individual whose information is being released

2. Provider Information: Details of the psychological service provider/practitioner

3. Information to be Released: Specific description of what information is authorized for release

4. Recipient Information: Details of who is authorized to receive the information

5. Duration of Consent: Time period for which the consent remains valid

6. Rights Statement: Information about the right to withdraw consent and data protection rights

7. Signatures: Space for client and witness signatures with dates

Optional Sections

1. Capacity Assessment: Section confirming capacity to consent, used when there are concerns about mental capacity

2. Third Party Authorization: Used when someone other than the client is providing consent (e.g., parent, guardian, power of attorney)

3. Specific Exclusions: Section detailing any information specifically excluded from the release authorization

4. Emergency Contact: Additional contact information for urgent situations

Suggested Schedules

1. Privacy Notice: Detailed information about how personal data will be processed

2. List of Records: Itemized list of specific documents/records to be released

3. Capacity Assessment Form: If required, detailed documentation of capacity assessment

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈ˰æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions




















Clauses















Relevant Industries
Relevant Teams
Relevant Roles
Industries

UK General Data Protection Regulation (UK GDPR): Primary data protection legislation covering principles of data processing, special category data protection (health data), rights of data subjects, and requirements for explicit consent

Data Protection Act 2018: UK implementation of GDPR including additional safeguards for health data and processing conditions for special category data

Access to Health Records Act 1990: Legislation governing rights of access to health records and provisions regarding deceased patients' records

Mental Capacity Act 2005: Law covering capacity to consent, best interests decision-making, and powers of attorney considerations in healthcare contexts

Health and Social Care Act 2012: Legislation establishing information governance requirements and healthcare records management standards

British Psychological Society Code of Ethics and Conduct: Professional guidelines setting standards for psychological practice and information handling

Health and Care Professions Council Standards: Regulatory standards for healthcare professionals including requirements for information management

NHS Information Governance: Guidelines and requirements for handling patient information within the healthcare system

Common Law Duty of Confidentiality: Legal principle establishing professional obligations and patient confidentiality requirements in healthcare settings

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,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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