Medical Records Request Form Template for Switzerland

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Key Requirements PROMPT example:

Medical Records Request Form

I need a Medical Records Request Form compliant with Swiss law for a research institution that will be collecting patient records from multiple hospitals in Zurich during March 2025, with specific provisions for data anonymization and research ethics compliance.

Document background

The Medical Records Request Form is an essential document used in the Swiss healthcare system to facilitate the legal and compliant transfer of medical information. It is required whenever patients, their authorized representatives, or qualified third parties need to access medical records from healthcare providers or institutions in Switzerland. The form ensures compliance with the Federal Act on Data Protection (FADP/DSG), cantonal health laws, and professional medical guidelines. It includes necessary provisions for identity verification, scope specification, and authorization validation, while respecting Switzerland's strict patient privacy requirements. This document is particularly important given the increasing digitalization of healthcare records and the need to maintain proper documentation of information access requests.

Suggested Sections

1. Patient Information: Essential details about the patient including full name, date of birth, address, contact information, and health insurance number (if relevant)

2. Requestor Information: Details of the person requesting the records (if different from patient), including their relationship to the patient and contact information

3. Healthcare Provider Details: Information about the healthcare provider or facility from whom the records are being requested

4. Records Request Specifications: Detailed description of which records are being requested, including date ranges and types of documents

5. Purpose of Request: Statement of the reason for requesting the medical records (required by Swiss law for documentation)

6. Delivery Preferences: Preferred method of receiving the records (electronic/paper) and delivery details

7. Privacy Notice: Statement about how the information will be handled and protected under Swiss data protection laws

8. Authorization: Legal authorization section with signature fields and date

Optional Sections

1. Urgent Request Declaration: Additional section for cases where expedited processing is required, including reason for urgency

2. Third Party Authorization Details: Extended authorization section when records are requested by legal representatives, guardians, or other authorized third parties

3. Research Use Declaration: Additional section required when records are being requested for research purposes under the Federal Act on Research involving Human Beings

4. International Transfer Notice: Required when records will be transferred outside of Switzerland, including additional data protection declarations

5. Cost Acknowledgment: Section detailing any applicable fees and payment method, if the provider charges for record copies

Suggested Schedules

1. Identity Verification Documents: List of acceptable identity verification documents and copies to be attached

2. Authorization Documentation: Templates or examples of required authorization documents for third-party requests

3. Fee Schedule: Detailed breakdown of any applicable fees for different types of record requests and delivery methods

4. Processing Timeframes: Standard processing times and conditions for expedited processing

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 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

Medical Research

Pharmaceuticals

Social Services

Education (Medical)

Government Health Services

Healthcare Technology

Relevant Teams

Legal

Compliance

Medical Records

Patient Services

Data Protection

Healthcare Administration

Quality Assurance

Information Management

Clinical Operations

Customer Service

Relevant Roles

Medical Records Administrator

Privacy Officer

Healthcare Compliance Manager

Medical Office Manager

Legal Counsel

Data Protection Officer

Healthcare Administrator

Clinical Research Coordinator

Insurance Claims Manager

Medical Secretary

Healthcare Quality Manager

Patient Services Coordinator

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