Release Of Health Information Form for Nigeria

Release Of Health Information Form Template for Nigeria

A standardized form used in Nigeria for authorizing the release of protected health information from one party to another, complying with the Nigeria Data Protection Act 2023 and relevant healthcare regulations. This document enables healthcare providers to share specified medical information with authorized recipients while protecting patient privacy rights and maintaining regulatory compliance. It includes detailed sections for patient identification, scope of information to be released, duration of authorization, and specific consents for sensitive information, all within the framework of Nigerian healthcare and privacy laws.

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What is a Release Of Health Information Form?

The Release of Health Information Form is a critical document used in the Nigerian healthcare system to facilitate the authorized sharing of patient medical information while ensuring compliance with privacy laws and regulations. This document becomes necessary when medical information needs to be shared between healthcare providers, with insurance companies, or other authorized parties. It must comply with the Nigeria Data Protection Act 2023, the National Health Act 2014, and other relevant healthcare regulations. The form includes specific provisions for patient identification, detailed description of information to be released, purpose of release, and duration of authorization. It may also include special provisions for sensitive information such as HIV status or mental health records. The document serves as a legal record of the patient's consent and protects healthcare providers from liability while ensuring patient privacy rights are maintained.

What sections should be included in a Release Of Health Information Form?

1. Patient Information: Essential identifying information including full name, date of birth, address, phone number, and medical record number

2. Healthcare Provider Information: Details of the healthcare provider/facility currently holding the medical records

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

4. Information to be Released: Specific description of what medical information is to be released, including date ranges

5. Purpose of Release: Statement of the reason for requesting the release of information

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. Authorization Statement: Formal declaration of consent and understanding of the release

9. Signature Block: Space for patient or authorized representative signature, date, and witness if required

What sections are optional to include in a Release Of Health Information Form?

1. Specific Consent for Sensitive Information: Additional authorization section for sensitive information like HIV status, mental health records, or genetic information - used when such specific records might be included

2. Representative Authority: Section for cases where someone other than the patient is authorizing the release, including space for documentation of authority

3. Fee Schedule: Information about any applicable fees for records copying - used when the provider charges for records

4. Electronic Delivery Authorization: Additional section for authorizing electronic transmission of records - used when digital delivery is an option

What schedules should be included in a Release Of Health Information Form?

1. Schedule A - Types of Medical Information: Detailed checklist of specific types of medical information that can be released (e.g., lab results, imaging reports, consultation notes)

2. Schedule B - Approved Delivery Methods: List of approved methods for transmitting the medical information (e.g., mail, fax, secure electronic transmission)

3. Appendix 1 - Patient Rights Summary: Detailed explanation of patient rights regarding medical information 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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Health Information Manager

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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 Release Of Health Information Form?

What sections should be included in a Release Of Health Information Form?

What sections are optional to include in a Release Of Health Information Form?

What schedules should be included in a Release Of Health Information Form?

Authors

Alex Denne

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