Medical Records Authorization Form

Medical Records Authorization Form Template for Singapore

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Key Requirements PROMPT example:

"I need a Medical Records Authorization Form to allow my insurance company to access my complete medical history from Singapore General Hospital, with the authorization valid for 6 months starting from January 15, 2025."

Document background

The Medical Records Authorization Form is essential in Singapore's healthcare ecosystem where strict data protection laws govern the handling of medical information. This document is required whenever medical records need to be shared with third parties, whether for continued care, insurance purposes, legal proceedings, or research. It ensures compliance with Singapore's PDPA 2012, Healthcare Services Act 2020, and relevant medical privacy regulations. The form specifies what information can be shared, with whom, and for how long, while protecting patient privacy rights and maintaining proper documentation of consent.

Suggested Sections

1. Patient Information: Full name, NRIC/FIN, contact details, and date of birth of the patient

2. Healthcare Provider Details: Name and details of the healthcare institution/provider holding the records

3. Scope of Authorization: Specific medical records being authorized for release and intended use

4. Duration of Authorization: Validity period of the authorization

5. Recipient Information: Details of the person/entity authorized to receive the records

6. Consent Declaration: Explicit consent statement and acknowledgment of understanding

Optional Sections

1. Proxy Authorization: Required when someone other than the patient is authorizing access to medical records

2. Special Categories of Records: Additional authorization for sensitive information such as HIV status, mental health records, or other specially protected health information

3. Electronic Access Authorization: Specific permissions and terms for electronic record access when digital access is requested

Suggested Schedules

1. Proof of Identity: Copies of identification documents required for verification

2. Legal Documentation: Power of attorney, court orders, or other legal documents establishing authority to access records

3. Fee Schedule: Schedule of applicable fees for record retrieval and copying services

Authors

Alex Denne

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

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Insurance
Legal Services
Research Institutions

Relevant Teams

Medical Records
Legal
Compliance
Administration
Privacy and Data Protection

Relevant Roles

Medical Records Officer
Healthcare Administrator
Compliance Officer
Privacy Officer
Medical Secretary

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Let's create your Medical Records Authorization Form

Authors

Alex Denne

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