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Consent To Release Medical Records
"I need a Consent To Release Medical Records form that allows my GP to share my full medical history with a specialist clinic in London, with the consent valid for 6 months starting from January 2025."
1. Patient Information: Full name, date of birth, address, NHS number or other unique identifier
2. Healthcare Provider Details: Name and address of the healthcare provider holding the records
3. Scope of Consent: Specific description of what medical records are being released
4. Recipient Information: Details of who is authorized to receive the records
5. Duration of Consent: Time period for which the consent is valid
6. Declaration and Signature: Patient's confirmation and signature, date of signing
1. Third Party Authorization: When someone other than the patient is authorized to consent
2. Specific Exclusions: When certain parts of the medical record are to be excluded from release
3. Purpose of Release: When the purpose needs to be specified (e.g., insurance, legal proceedings)
4. Capacity Assessment: When there are questions about the patient's capacity to consent
1. List of Specific Records: Detailed inventory of specific records to be released
2. Proof of Identity: Copies of identity documents when required
3. Power of Attorney/Court Order: When consent is given by someone other than the patient
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