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1. Parties: Identifies all relevant parties: the client/patient, the therapist/practice, and the intended recipient(s) of the information
2. Background: Brief context explaining the purpose of the release form and its importance in maintaining privacy while facilitating necessary information sharing
3. Definitions: Clear definitions of key terms used in the document, including types of information, therapeutic relationship, and relevant legal terms
4. Scope of Information Release: Detailed specification of exactly what information is authorized for release, including session notes, assessments, diagnoses, or treatment plans
5. Purpose of Release: Clear statement of why the information is being released and how it will be used
6. Duration of Authorization: Specifies how long the authorization for release remains valid
7. Rights and Revocation: Explains the client's rights regarding the release, including the right to revoke authorization
8. Privacy Notices: Mandatory privacy notices and statements required under Australian Privacy Principles
9. Execution: Signature blocks for all relevant parties, including dates and witness requirements
1. Electronic Records Release: Additional provisions for release of information from My Health Record or other electronic health record systems
2. Interstate/International Transfer: Special provisions for when information is being released to recipients in other states or countries
3. Minor Client Provisions: Special provisions when the client is under 18, including parental/guardian consent requirements
4. Emergency Contact Authorization: Optional section for authorizing information release to emergency contacts under specific circumstances
5. Research Use Authorization: Additional provisions if the information may be used for research purposes
1. Schedule A - Specific Information Authorized for Release: Detailed checklist of specific documents and information types authorized for release
2. Schedule B - Authorized Recipients: List of specific individuals or organizations authorized to receive the information, including their contact details and professional credentials
3. Schedule C - Privacy Policy Summary: Summary of relevant privacy policies and procedures for handling sensitive information
4. Appendix 1 - Revocation Form: Standard form for revoking the authorization for release of information
Clinical Notes
Confidential Information
Consent
Healthcare Provider
Health Information
Mental Health Records
Personal Information
Protected Health Information
Provider
Release Authorization
Revocation
Sensitive Information
Session Notes
Therapeutic Relationship
Treatment Records
Third Party
Valid Consent
Healthcare Identifier
Mental Health Professional
Professional Services
Medical Records
Electronic Health Records
Disclosure
Client/Patient
Practice
Authorized Representative
Emergency Contact
Mental Health Treatment Plan
Confidentiality Agreement
Privacy Policy
Information Exchange
Health Service
Clinical Assessment
Duration of Authorization
Privacy
Confidentiality
Information Access
Data Protection
Authorization
Revocation Rights
Duration
Information Scope
Recipient Rights
Emergency Disclosure
Record Keeping
Electronic Records
Information Security
Third Party Disclosure
Legal Compliance
Healthcare Standards
Patient Rights
Professional Obligations
Liability
Jurisdiction
Amendments
Termination
Dispute Resolution
Healthcare
Mental Health Services
Medical Practices
Psychology
Counseling Services
Social Services
Insurance
Legal Services
Education (for student mental health services)
Disability Services
Legal
Compliance
Clinical Operations
Medical Records
Privacy and Data Protection
Quality Assurance
Administrative Support
Patient Services
Risk Management
Healthcare Information Management
Psychologist
Psychiatrist
Mental Health Counselor
Clinical Social Worker
Practice Manager
Healthcare Administrator
Compliance Officer
Privacy Officer
Medical Records Manager
Mental Health Nurse
Occupational Therapist
Legal Counsel
Insurance Claims Processor
Clinical Director
Quality Assurance Manager
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