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1. Form Title and Date: Clear identification of the document as an Authorization for Release of Information Form, including the date of execution
2. Individual's Information: Complete details of the person whose information will be released (full name, Emirates ID, contact details, etc.)
3. Authorizing Declaration: Clear statement that the individual is voluntarily authorizing the release of information
4. Information to be Released: Specific description of the information authorized for release, including its nature and scope
5. Purpose of Release: Clear statement of why the information is being released and how it will be used
6. Recipient Information: Details of the person(s) or organization(s) authorized to receive the information
7. Duration of Authorization: Specific timeframe for which the authorization is valid
8. Rights and Revocation: Statement of the individual's rights, including the right to revoke authorization
9. Signatures: Space for signatures of the authorizing individual, witness, and/or notary as required
1. Medical Information Specifics: Additional section when the authorization involves medical records, including specific health information categories and special consents required under UAE healthcare regulations
2. Third Party Authorization: Section to be included when someone other than the individual is authorized to act on their behalf, including legal guardian details or power of attorney references
3. Digital Processing Consent: Additional consent section for electronic processing and storage of the authorization, required when the form will be processed digitally
4. Cross-Border Transfer: Special provisions when information will be transferred outside the UAE, including additional consents required under UAE data protection laws
5. Translation Declaration: To be included when the form is bilingual or translated, confirming the accuracy of the translation
1. Schedule A - Detailed Information List: Comprehensive list of specific information/documents authorized for release
2. Schedule B - Authorized Recipients: Detailed list of all authorized recipients and their contact information when multiple recipients are involved
3. Appendix 1 - Identity Verification Documents: Copies of required identification documents to be attached to the authorization
4. Appendix 2 - Supporting Documentation: Any additional documents supporting the authorization (e.g., power of attorney, legal guardian certification)
Authorized Representative
Confidential Information
Data Subject
Disclosure
Emirates ID
Information Holder
Personal Data
Processing
Recipient
Records
Release
Sensitive Personal Data
Third Party
Consent
Revocation
Data Protection Law
Authorization Period
Processing Purpose
Information Security
Healthcare
Banking and Financial Services
Insurance
Education
Government Services
Real Estate
Legal Services
Employment Services
Telecommunications
Professional Services
Legal
Compliance
Human Resources
Information Security
Risk Management
Operations
Administrative Services
Customer Service
Records Management
Data Protection
Compliance Officer
Legal Counsel
Human Resources Manager
Medical Records Administrator
Privacy Officer
Data Protection Officer
Information Security Manager
Risk Manager
Corporate Secretary
Operations Manager
Customer Service Manager
Administrative Officer
Records Manager
Facilities Manager
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