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1. Parties: Identification of the patient (data subject), the releasing healthcare provider, and the recipient of the medical records
2. Background: Brief context explaining the purpose of the release form and its legal basis under GDPR and German law
3. Definitions: Key terms used in the document, including types of medical records, processing activities, and relevant legal terminology
4. Scope of Authorization: Detailed description of which medical records are authorized for release, including date ranges and types of information
5. Purpose of Disclosure: Specific purpose(s) for which the medical information will be used
6. Duration of Authorization: Time period for which the authorization is valid
7. Rights of the Patient: Statement of patient rights under GDPR and German law, including right to revoke authorization
8. Data Protection Notice: Required information about data processing under GDPR Article 13/14
9. Signatures: Execution section for patient (or legal representative) and witness signatures
1. Emergency Contact Authorization: Additional authorization for emergency contacts to access records, used when patient wants to designate emergency contacts
2. Special Categories Authorization: Specific authorization for sensitive information like mental health or genetic data, used when such records are involved
3. Digital Access Provisions: Terms for electronic access to records, used when digital transfer methods are available
4. Third Party Payment Authorization: Authorization for billing and payment information release, used when payment processing is involved
5. International Transfer Provisions: Additional provisions for cross-border data transfers, used when records will be sent outside Germany
1. Schedule A - Types of Medical Records: Detailed checklist of specific medical record types authorized for release
2. Schedule B - Authorized Recipients: List of specific individuals or organizations authorized to receive the records
3. Schedule C - Privacy Notice: Detailed privacy notice compliant with GDPR Article 13/14 requirements
4. Appendix 1 - Revocation Form: Standard form for revoking the authorization
5. Appendix 2 - Fee Schedule: If applicable, schedule of fees for record copying and transmission
Protected Health Information
Data Subject
Data Controller
Data Processor
Healthcare Provider
Authorized Recipient
Consent
Processing
Special Categories of Personal Data
Transfer
Release Authorization
Treatment
Health Information
Disclosure
Revocation
Legal Representative
Third Party
Data Protection Officer
Medical Documentation
Electronic Health Records
Emergency Contact
Healthcare Institution
Confidential Information
Patient Rights
Authorization Period
Medical Professional
Personal Data
Consent
Authorization
Confidentiality
Privacy Notice
Information Access
Duration
Revocation Rights
Data Transfer
Record Types
Purpose Limitation
Patient Rights
Third Party Disclosure
Data Security
Emergency Access
Liability
Fee Schedule
Governing Law
Dispute Resolution
Electronic Records
International Transfer
Healthcare
Medical Insurance
Medical Research
Healthcare Technology
Legal Services
Hospital Administration
Pharmaceutical Industry
Clinical Trials
Public Health
Legal
Compliance
Medical Records
Patient Administration
Data Protection
Clinical Operations
Medical Information Management
Patient Services
Research Administration
Quality Assurance
Privacy Office
Medical Records Administrator
Data Protection Officer
Healthcare Compliance Manager
Medical Office Manager
Clinical Director
Legal Counsel
Privacy Officer
Hospital Administrator
Medical Secretary
Healthcare Documentation Specialist
Patient Relations Manager
Medical Information Officer
Research Coordinator
Healthcare Legal Advisor
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