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Authorisation For Release Of Records
"I need an Authorisation For Release Of Records to allow my new employer to access my medical records from London Bridge Hospital for the past 5 years, with the authorization valid from January 2025 to March 2025."
1. Authoriser Details: Full name, address, date of birth, contact information of person authorising release
2. Records Holder Information: Details of organization/person holding the records
3. Records Description: Specific description of records to be released
4. Recipient Information: Details of person/organization authorized to receive records
5. Purpose of Release: Stated purpose for which records are being released
6. Duration of Authorization: Time period for which authorization remains valid
7. Signature and Date: Authorization signature and dating requirements
1. Third Party Authorization: Additional authorization requirements when records are to be released to someone other than the subject
2. Specific Exclusions: Details of any records specifically excluded from release
3. Witness Requirements: Witness signature requirements when required by specific circumstances or record types
1. Identity Verification Documents: Copies of required ID documents to be attached
2. Power of Attorney: Documentation proving authority to act on behalf of another person
3. Specific Records List: Detailed inventory of records to be released when extensive
Authors
Records
Records Holder
Authorised Recipient
Confidential Information
Personal Data
Special Category Data
Data Protection Legislation
Effective Date
Expiry Date
Purpose
Authority
Permitted Use
Relevant Records
Excluded Records
Third Party
Authorized Representatives
Data Subject
Processing
Consent
Scope of Records
Duration and Expiry
Confidentiality
Data Protection
Purpose Limitation
Records Description
Access Rights
Revocation Rights
Consent
Representations and Warranties
Third Party Rights
Disclosure Restrictions
Copy Rights
Redaction Rights
Storage and Security
Further Disclosure
Governing Law
Execution Requirements
Witness Requirements
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