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Therapy Release Of Information Template
I need a Therapy Release Of Information Template for my private psychology practice that specifically allows sharing information with a research team at Oxford University while ensuring GDPR compliance and including special provisions for sharing anonymized data for their study starting March 2025.
1. Client Information: Basic identifying information about the client including name, date of birth, contact details and any relevant identification numbers
2. Therapist Information: Professional details of the therapist/practice including name, registration numbers, practice address and contact information
3. Information to be Released: Specific details of what information can be shared, including type of records, date ranges, and level of detail permitted
4. Purpose of Release: Clearly stated purpose for which information is being released and how it will be used
5. Duration of Authorization: Time period for which the release is valid, including start and end dates
6. Rights and Revocation: Client's rights regarding their data and detailed process for revoking consent
1. Emergency Contact Authorization: Additional permissions for emergency contacts to receive information in crisis situations
2. Electronic Communications Consent: Specific permissions for digital information sharing, including email, messaging, and electronic records transfer
3. Third Party Payment Authorization: Permission to share necessary information with insurance providers or other third-party payers
1. Schedule A: Specific Records: Detailed list of specific records authorized for release, including session notes, assessments, and treatment plans
2. Schedule B: Authorized Recipients: Comprehensive list of specifically authorized individuals or organizations permitted to receive information
3. Appendix 1: Privacy Notice: Detailed privacy information and GDPR notices as required by UK data protection legislation
4. Appendix 2: Client Rights: Comprehensive explanation of client rights regarding their information under UK law and professional guidelines
Authors
Client/Patient
Confidential Information
Consent
Data Controller
Data Protection Laws
Data Subject Rights
Effective Date
Emergency Contact
Healthcare Provider
Information Disclosure
Mental Health Professional
Personal Data
Practice
Protected Health Information
Recipient
Release Authorization
Revocation
Special Category Data
Term
Therapeutic Records
Therapist
Third Party
Treatment Information
Valid Period
Confidentiality
Data Protection
Duration and Termination
Emergency Disclosure
Information Scope
Information Storage
Patient Rights
Privacy
Purpose of Disclosure
Record Keeping
Recipient Details
Revocation Rights
Security Measures
Third Party Access
Time Limitations
Transfer Restrictions
Use Limitations
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