Consent To Disclose Medical Information Form for Ireland

Consent To Disclose Medical Information Form Template for Ireland

This document is a standardized consent form used in Ireland for authorizing the disclosure of medical information, compliant with both Irish law and EU GDPR requirements. It enables patients or their authorized representatives to give explicit permission for the sharing of their medical records between specified parties. The form incorporates key requirements from the Irish Data Protection Act 2018 and relevant healthcare legislation, ensuring proper handling of sensitive personal health data while maintaining patient privacy rights and providing clear documentation of consent for medical information transfers.

Your data doesn't train Genie's AI

You keep IP ownership of your information

Generate a Bespoke Document

1. Select your governing law:

2. Enter your key requirements:

3. Create your document to edit, review or download

Download a Standard Template

Get our Ireland-compliant Consent To Disclose Medical Information Form

4.6 / 5

4.8 / 5

Alternatively: Run an advanced review of an existing
Consent To Disclose Medical Information Form

Let Genie AI's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.

Upload your Doc

What is a Consent To Disclose Medical Information Form?

The Consent To Disclose Medical Information Form is a crucial document used in the Irish healthcare system to facilitate the authorized sharing of patient medical information. This form is required whenever patient medical records need to be transferred between healthcare providers, shared with insurance companies, or disclosed to other authorized parties. It ensures compliance with the General Data Protection Regulation (GDPR), the Irish Data Protection Act 2018, and various healthcare regulations. The document includes specific provisions for identifying the patient, detailing the scope of information to be shared, naming authorized recipients, and specifying the duration of consent. It's particularly important in maintaining patient privacy rights while enabling necessary information sharing for continued care, insurance purposes, or legal requirements.

What sections should be included in a Consent To Disclose Medical Information Form?

1. Patient Information: Full legal name, date of birth, address, contact details, and medical record number of the patient

2. Healthcare Provider Details: Name, address, and contact information of the healthcare provider/facility currently holding the medical records

3. Recipient Information: Details of the person(s) or organization(s) authorized to receive the medical information

4. Scope of Disclosure: Specific description of what medical information can be disclosed, including date ranges and types of records

5. Purpose of Disclosure: Clear statement of why the information is being disclosed

6. Duration of Consent: Time period for which the consent remains valid

7. Rights Statement: Explanation of patient's rights including right to withdraw consent and right to receive a copy

8. Signatures: Space for patient (or authorized representative) signature, date, and witness if required

What sections are optional to include in a Consent To Disclose Medical Information Form?

1. Representative Authorization: Section for cases where someone other than the patient is providing consent, including proof of authority

2. Special Categories: Additional specific consent for sensitive information like mental health, HIV status, or genetic information

3. Emergency Contact: Details of who to contact in emergency situations

4. Electronic Communications Consent: Specific consent for electronic transmission of records

5. Payment Information: Section for any applicable fees for record copying or transmission

6. Third Party Disclosure: Additional provisions for sharing with third parties beyond the initial recipient

What schedules should be included in a Consent To Disclose Medical Information Form?

1. Schedule A - Types of Medical Information: Detailed checklist of specific types of medical information that may be disclosed (e.g., test results, prescriptions, surgical records)

2. Schedule B - Authorized Recipients List: Comprehensive list of all authorized recipients and their contact details, if multiple recipients are involved

3. Schedule C - Information Transfer Methods: Approved methods for transferring the medical information (e.g., post, secure email, fax)

4. Appendix 1 - Glossary: Definitions of medical and technical terms used in the form

5. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how the information will be handled and protected

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

Cost

Free to use

Relevant legal definitions

Clauses

Data Protection
Consent
Authorization
Information Access
Confidentiality
Privacy
Duration
Withdrawal Rights
Information Security
Data Transfer
Third Party Disclosure
Patient Rights
Record Handling
Emergency Provisions
Electronic Communications
Liability
Regulatory Compliance
Signature Requirements

Relevant Industries

Healthcare

Insurance

Legal Services

Social Services

Occupational Health

Medical Research

Pharmaceutical

Education (Medical Institutions)

Sports and Recreation

Government Health Services

Relevant Teams

Legal Compliance

Medical Records

Data Protection

Patient Services

Healthcare Administration

Risk Management

Clinical Operations

Information Governance

Quality Assurance

Insurance Processing

Relevant Roles

Medical Records Officer

Data Protection Officer

Healthcare Administrator

Clinical Director

Legal Compliance Manager

Privacy Officer

Medical Secretary

Insurance Claims Processor

Healthcare Operations Manager

Patient Services Coordinator

Medical Practice Manager

Clinical Research Coordinator

Find the exact document you need

No matches found.

Patient Consent To Release Information Form

An Irish-law governed patient consent form for authorizing the release of medical information, compliant with GDPR and local healthcare regulations.

How Cambridge United Uses Genie AI to Speed Up Player Signings and Slash Legal Costs

Generate a Bespoke Document

Download a Standard Template

What is a Consent To Disclose Medical Information Form?

What sections should be included in a Consent To Disclose Medical Information Form?

What sections are optional to include in a Consent To Disclose Medical Information Form?

What schedules should be included in a Consent To Disclose Medical Information Form?

Authors

Alex Denne

Jurisdiction

Publisher

Document Type

Sector

Cost

Find the exact document you need

Patient Consent To Release Information Form

Online Release Form

Consent To Disclose Medical Information Form

Voice Release Form

Release Information Consent Form

Authorization To Release Employee Information Form

Medical Information Disclosure Consent Form

Consent Form For Release Of Information

Tenant Release Form

Consent Form For Social (Media)

3rd Party Release Form

Medical Photo Consent Form

Travel Release Form For Minor

Consent Form To Share Information

Authorization To Disclose Protected Health Information

Medical Records Form

Babysitter Medical Consent Form

Reference Release Authorization Form

Personal Release And Consent Form

Motor Vehicle Release Form

Motor Vehicle Accident Release Form

Employment Background Check Consent Form

Employee Key Release Form

Digital Release Form

Consent To Disclose Information Form

Simple Medical Release Form

Protected Health Information Form

Package Release Form

Mental Health Records Release Form

Medical Release Form For Family Members

Medical Release Consent Form

Dental Records Request Form

Actor Release Form

Criminal Release Form

Minor Actor Release Form

Allergy Release Form

Video Consent Form For Minors

Permission To Discuss Medical Information Form

Consent Form To Share Medical Information

Consent Form To Release Medical Information To A Third Party

Genie’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security:

Use Cases

Generate Legal Docs Free