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1. Parties: Identification of the data subject (person whose information will be released) and the organization/entity requesting/holding the information
2. Background: Brief context explaining the purpose of the information release
3. Definitions: Clear explanations of key terms used in the form, including types of information, processing activities, and relevant parties
4. Scope of Information: Detailed specification of exactly what information is authorized for release
5. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the information will be used
6. Duration of Authorization: Specific timeframe for which the authorization is valid
7. Rights of the Data Subject: Statement of rights under GDPR and German law, including right to withdraw consent
8. Data Protection Measures: Overview of how the information will be protected during transfer and storage
9. Declarations and Signatures: Formal authorization statements and signature blocks for all parties
1. Third Party Recipients: Section to be included when information may be shared with additional third parties beyond the primary recipient
2. International Transfer Provisions: Required when information may be transferred outside the EU/EEA
3. Special Categories of Data: Additional provisions required when handling sensitive data categories under Article 9 GDPR
4. Emergency Contact Authorization: Optional section for authorizing release of information to emergency contacts
5. Digital Communication Consent: Optional section for consent to receive information via email or other electronic means
1. Schedule A - Detailed Information Inventory: Itemized list of specific records/information to be released
2. Schedule B - Authorized Recipients List: Detailed list of all authorized recipients and their contact information
3. Appendix 1 - Privacy Notice: Detailed privacy notice as required by GDPR Article 13/14
4. Appendix 2 - Security Measures: Description of technical and organizational measures for data protection
Special Categories of Personal Data
Data Subject
Data Controller
Data Processor
Authorized Recipients
Processing
Consent
Information Release
Authorization Period
Third Party
Transfer
Confidential Information
Data Protection Officer
Supervisory Authority
Privacy Notice
Data Subject Rights
Technical and Organizational Measures
Cross-border Transfer
Legitimate Interest
Purpose Limitation
Data Minimization
Storage Period
Withdrawal of Consent
Security Breach
Documentation
Electronic Processing
Authorized Representative
Purpose Limitation
Data Protection
Information Scope
Duration
Revocation Rights
Confidentiality
Data Security
Third Party Disclosure
Cross-border Transfer
Data Subject Rights
Processing Limitations
Record Keeping
Liability
Emergency Disclosure
Electronic Communication
Governing Law
Dispute Resolution
Severability
Amendment
Healthcare
Education
Financial Services
Insurance
Human Resources
Legal Services
Social Services
Research and Development
Public Administration
Professional Services
Legal
Compliance
Data Protection
Human Resources
Information Security
Risk Management
Operations
Customer Service
Medical Records
Administrative Services
Information Technology
Privacy Office
Data Protection Officer
Privacy Manager
Compliance Officer
Legal Counsel
Human Resources Manager
Medical Records Administrator
Information Security Manager
Risk Management Officer
Operations Manager
Customer Service Manager
Healthcare Administrator
Education Administrator
Records Manager
GDPR Specialist
Privacy Coordinator
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