Authorization For Release Of Medical Record Information for Nigeria

Authorization For Release Of Medical Record Information Template for Nigeria

This document serves as a legal authorization for the release of medical record information in Nigeria, complying with the National Health Act 2014 and Nigeria Data Protection Regulation (NDPR) 2019. It enables healthcare providers to share specified medical records with authorized recipients while protecting patient privacy rights. The document includes detailed patient identification, specific records to be released, purpose of disclosure, duration of authorization, and necessary signatures. It incorporates safeguards for sensitive information and ensures compliance with Nigerian healthcare information management requirements.

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What is a Authorization For Release Of Medical Record Information?

The Authorization For Release Of Medical Record Information is a crucial document in Nigerian healthcare administration, designed to facilitate the legal and secure transfer of patient medical information. This document is required whenever patient medical records need to be shared with third parties, whether for continuing medical care, insurance purposes, legal proceedings, or other authorized purposes. It must comply with the National Health Act 2014 and NDPR 2019, which govern the handling of medical information in Nigeria. The authorization form serves as a protective measure for both healthcare providers and patients, ensuring that sensitive medical information is only released with proper consent and for specified purposes. It includes specific details about what information can be released, to whom, for what purpose, and for how long the authorization remains valid.

What sections should be included in a Authorization For Release Of Medical Record Information?

1. Patient Information: Full legal name, date of birth, address, contact information, and any relevant patient ID numbers

2. Healthcare Provider Information: Name and details of the healthcare facility/provider currently holding the records

3. Recipient Information: Name and details of the person/entity authorized to receive the medical records

4. Records to be Released: Specific description of medical records authorized for release, including date ranges

5. Purpose of Disclosure: Clear statement of the reason for releasing the medical records

6. Duration of Authorization: Specific timeframe for which the authorization is valid

7. Rights and Notices: Statement of patient's rights including right to revoke authorization and any limitations

8. Signatures and Date: Space for patient or legal representative signature, witness signature if required, and date

What sections are optional to include in a Authorization For Release Of Medical Record Information?

1. Legal Representative Authorization: Required when someone other than the patient is authorizing the release, including proof of authority

2. Specific Consent for Sensitive Information: Additional authorization section for sensitive information like HIV status, mental health records, or genetic information

3. Re-disclosure Notice: Additional warnings about potential re-disclosure of information, particularly relevant for international transfers

4. Payment Information: Required when there are fees associated with copying and sending records

5. Emergency Contact Information: Optional section for including emergency contact details when relevant to the purpose of disclosure

What schedules should be included in a Authorization For Release Of Medical Record Information?

1. Schedule A - Detailed Record List: Itemized list of specific medical records to be released, including dates and types of records

2. Schedule B - Special Instructions: Any special handling instructions for sensitive records or specific format requirements

3. Appendix 1 - Glossary of Medical Terms: Optional glossary explaining medical terminology used in describing records to be released

4. Appendix 2 - Patient Rights Summary: Detailed explanation of patient rights regarding medical records under Nigerian law

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

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Info Release Form

A Nigerian law-compliant document authorizing the controlled release of information between parties, incorporating NDPR requirements and data protection principles.

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What is a Authorization For Release Of Medical Record Information?

What sections should be included in a Authorization For Release Of Medical Record Information?

What sections are optional to include in a Authorization For Release Of Medical Record Information?

What schedules should be included in a Authorization For Release Of Medical Record Information?

Authors

Alex Denne

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