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Consent Letter For Medical Report
"I need a Consent Letter for Medical Report to authorize Singapore General Hospital to release my complete medical history from the past 5 years to my insurance company (AIA Singapore) for a critical illness claim, with the consent valid until March 2025."
1. Patient Information: Full name, NRIC/Passport number, date of birth, contact details of the patient
2. Healthcare Provider Details: Name of hospital/clinic, doctor's name, registration number and contact information
3. Purpose Statement: Clear statement of purpose for medical report request and intended use
4. Scope of Disclosure: Specific medical information to be released and any limitations on disclosure
5. Recipient Information: Details of person/organization authorized to receive the medical report
6. Duration of Validity: Period for which the consent remains valid and expiration date if applicable
1. Third Party Authorization: Authorization details when someone other than patient is permitted to collect the report
2. Special Instructions: Any specific requirements or format specifications for the medical report
3. Legal Representative Details: Information about guardian or appointed representative when patient lacks mental capacity or is a minor
1. Identity Verification Documents: Copies of NRIC/Passport of patient and/or authorized person
2. Power of Attorney Documentation: Legal documentation of representation rights where applicable
3. Previous Consent Forms: Copies of previous consent forms if this is an extension or modification
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