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1. Date and Location: Current date and place where the letter is being written
2. Healthcare Provider Details: Full name and address of the hospital or medical facility holding the records
3. Patient Information: Complete identification details of the patient including full name, date of birth, NHI number, and current address
4. Authorized Recipient: Full details of the person or entity being authorized to access the records, including their relationship to the patient
5. Scope of Authorization: Specific description of what records are being authorized for release and for what time period
6. Purpose of Authorization: Clear statement of why the records are being requested and how they will be used
7. Duration of Authorization: Specific timeframe for which the authorization is valid
8. Patient Declaration: Statement confirming the patient's consent and understanding of the authorization
9. Signature Block: Space for patient's signature, date, and witness signature if required
1. Urgent Request Indicator: Section to be included when records are needed urgently, specifying the timeframe and reason for urgency
2. Special Handling Instructions: Any specific requirements for how the records should be handled, transmitted, or protected
3. Previous Records Request Reference: To be included if this is a follow-up to a previous request
4. Mental Health Records Clause: Special authorization section specifically for mental health records, which may require additional privacy considerations
5. Third Party Authorization: Additional section when the person signing is not the patient but has legal authority to do so (e.g., power of attorney, parent of minor)
1. Identification Documents: Copies of relevant identification documents for both the patient and authorized recipient
2. Power of Attorney / Legal Authority: If applicable, documentation proving legal authority to request records on behalf of the patient
3. Specific Records Checklist: Detailed list of specific records being requested, with date ranges and types of information
Medical Records
Healthcare Provider
Authorized Recipient
Authorization Period
NHI Number
Patient
Confidential Information
Personal Information
Health Services
Treatment Records
Medical History
Clinical Notes
Diagnostic Results
Mental Health Records
Discharge Summary
Electronic Health Records
Laboratory Results
Authorized Purpose
Legal Representative
Healthcare
Insurance
Legal Services
Social Services
Government Services
Medical Research
Healthcare Administration
Disability Services
Aged Care
Mental Health Services
Legal Affairs
Medical Records
Compliance
Patient Services
Risk Management
Privacy & Data Protection
Healthcare Administration
Information Management
Clinical Operations
Quality Assurance
Medical Records Administrator
Privacy Officer
Healthcare Administrator
Legal Compliance Officer
Medical Secretary
Clinical Director
Insurance Claims Processor
Healthcare Privacy Specialist
Medical Records Clerk
Patient Services Coordinator
Legal Administrator
Healthcare Operations Manager
Risk Management Officer
Medical Information Officer
Health Information Manager
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All data stored on Genie is private to your organisation
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You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it


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