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1. Requester Information: Details of the person or organization requesting the information, including full name, contact details, and any relevant identification numbers
2. Information Owner Details: Full details of the person whose information is being released (if different from requester), including name, date of birth, and contact information
3. Information Holder Details: Details of the organization or entity that currently holds the information and is being authorized to release it
4. Information to be Released: Specific description of the information to be released, including type, date range, and format of information
5. Purpose of Release: Clear statement of why the information is being requested and how it will be used
6. Authorization Statement: Explicit consent statement authorizing the release of information, including reference to relevant privacy laws
7. Signature Block: Space for signatures, dates, and witness details if required
1. Time Limitation: Section specifying the duration for which the authorization is valid, used when the release permission should not be indefinite
2. Third Party Authorization: Additional section for cases where information may be released to parties other than the primary requester
3. Specific Exclusions: Section detailing any specific information that should NOT be released, used when certain information needs to be withheld
4. Security Requirements: Special handling or security requirements for sensitive information, used for confidential or sensitive data
5. Revocation Rights: Details about how and when the authorization can be revoked, particularly important for ongoing or future releases
1. Schedule 1 - Detailed Information List: Comprehensive list of specific documents or information to be released when the main form needs to reference a detailed inventory
2. Schedule 2 - Authorized Recipients: List of specific individuals or organizations authorized to receive the information, used when multiple recipients are involved
3. Appendix A - Identity Verification Requirements: Details of acceptable forms of identification and verification procedures
4. Appendix B - Privacy Notice: Detailed privacy notice explaining how the released information will be handled and protected
Sensitive Information
Health Information
Information Owner
Information Holder
Authorized Representative
Requesting Party
Third Party Recipient
Consent
Authorization Period
Privacy Act
Confidential Information
Disclosure
Information Release
Electronic Record
Written Notice
Revocation
Purpose of Release
Agency
Privacy Officer
Health Provider
Identifying Information
Records
Consent
Information Scope
Purpose of Release
Duration
Privacy Protection
Information Handling
Third Party Disclosure
Confidentiality
Security Measures
Rights and Obligations
Revocation Rights
Liability and Indemnification
Compliance with Law
Electronic Communications
Amendment and Termination
Verification and Authentication
Record Keeping
Healthcare
Education
Financial Services
Legal Services
Government
Insurance
Human Resources
Social Services
Research
Professional Services
Legal
Compliance
Human Resources
Records Management
Information Security
Administrative Services
Medical Records
Customer Service
Risk Management
Privacy Office
Privacy Officer
Compliance Manager
Legal Counsel
Human Resources Manager
Medical Records Administrator
Information Security Officer
Data Protection Officer
Records Manager
Administrative Assistant
Department Manager
Healthcare Provider
School Administrator
Financial Advisor
Insurance Claims Officer
Government Official
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Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
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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