The Consent To Release Medical Information document serves as a critical tool in Philippine healthcare settings where patient privacy and data protection are paramount. This document becomes necessary when medical information needs to be shared between healthcare providers, insurance companies, legal representatives, or other authorized parties. It ensures compliance with the Data Privacy Act of 2012 and relevant healthcare regulations in the Philippines, while protecting patient rights and healthcare provider liability. The document typically includes specific details about what information can be released, to whom, for what purpose, and for how long the authorization remains valid. It's particularly important in cases involving insurance claims, continuing care, legal proceedings, or research purposes, where proper documentation of consent is essential for the lawful disclosure of confidential medical information.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Genie AI's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
Upload your Doc
1. Parties: Identifies the patient (grantor of consent), the healthcare provider/facility holding the records, and the recipient(s) of the medical information
2. Background: Brief context explaining why the medical information needs to be released
3. Definitions: Defines key terms used in the document, including types of medical information, healthcare providers, and other relevant terms
4. Scope of Information: Detailed description of the specific medical information authorized for release, including time periods covered
5. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the medical information will be used
6. Duration of Consent: Specifies how long the consent remains valid and when it expires
7. Rights and Revocation: Explains the patient's rights, including the right to revoke consent and the process for doing so
8. Privacy Protection: Specifies how the released information will be protected and handled in compliance with privacy laws
9. Execution: Signature block for all parties, including witness requirements and date of signing
1. Electronic Transmission Authorization: Required when medical records may be transmitted electronically, specifying security measures and acceptable transmission methods
2. Third Party Authorization: Used when allowing the recipient to further share the information with specified third parties
3. Special Categories of Information: Required when releasing sensitive information like HIV status, mental health records, or genetic information that requires specific consent under Philippine law
4. Language Certification: Required when the patient's primary language is not English or Filipino, certifying that the document has been explained in their preferred language
5. Emergency Contact Authorization: Optional section authorizing release of information to emergency contacts under specific circumstances
1. Schedule A - Specific Medical Records: Detailed listing of specific medical records authorized for release, including dates, types of records, and any exclusions
2. Schedule B - Authorized Recipients: List of all authorized recipients of the medical information, including their contact details and roles
3. Appendix 1 - Revocation Form: Standard form for revoking the consent, including instructions for submission
4. Appendix 2 - Privacy Notice: Detailed privacy notice in compliance with the Data Privacy Act of 2012, explaining how the information will be handled
Relevant legal definitions
Medical Information
Protected Health Information
Healthcare Provider
Medical Records
Authorized Recipient
Consent
Personal Information
Sensitive Personal Information
Data Privacy
Healthcare Facility
Medical Records Officer
Disclosure
Authorization Period
Revocation
Legal Representative
Electronic Health Records
Treatment
Health Care Operations
Medical History
Confidential Information
Data Processing
Data Controller
Data Subject
Third Party
Minor Patient
Emergency Contact
Protected Health Information
Healthcare Provider
Medical Records
Authorized Recipient
Consent
Personal Information
Sensitive Personal Information
Data Privacy
Healthcare Facility
Medical Records Officer
Disclosure
Authorization Period
Revocation
Legal Representative
Electronic Health Records
Treatment
Health Care Operations
Medical History
Confidential Information
Data Processing
Data Controller
Data Subject
Third Party
Minor Patient
Emergency Contact
Clauses
Consent and Authorization
Data Privacy
Confidentiality
Information Access
Duration and Expiry
Rights and Obligations
Revocation Rights
Data Protection
Purpose Limitation
Disclosure Parameters
Electronic Transmission
Liability and Indemnification
Witness Requirements
Governing Law
Medical Records Scope
Third Party Disclosure
Emergency Provisions
Representations and Warranties
Severability
Execution
Data Privacy
Confidentiality
Information Access
Duration and Expiry
Rights and Obligations
Revocation Rights
Data Protection
Purpose Limitation
Disclosure Parameters
Electronic Transmission
Liability and Indemnification
Witness Requirements
Governing Law
Medical Records Scope
Third Party Disclosure
Emergency Provisions
Representations and Warranties
Severability
Execution
Relevant Industries
Healthcare
Insurance
Legal Services
Medical Research
Pharmaceuticals
Education (Medical Institutions)
Government Health Services
Employee Benefits
Social Services
Public Health
Relevant Teams
Legal
Compliance
Medical Records
Privacy and Data Protection
Patient Services
Risk Management
Quality Assurance
Administrative Services
Human Resources
Information Security
Relevant Roles
Medical Records Officer
Privacy Officer
Compliance Manager
Healthcare Administrator
Medical Director
Legal Counsel
Risk Manager
Insurance Claims Processor
Clinical Research Coordinator
Human Resources Manager
Healthcare Facility Manager
Patient Relations Officer
Medical Secretary
Quality Assurance Manager
Data Protection Officer
Find the exact document you need
Vehicle Release Form From Police Department
An official Philippine National Police document authorizing and recording the release of an impounded vehicle to its verified owner or representative under Philippine law.
Download
Simple Photo Consent Form
A Philippine-compliant Photo Consent Form for authorized photograph capture and usage, aligned with local privacy and data protection laws.
Download
Release Of Personal Information Consent Form
A Philippine-compliant consent form for the collection and processing of personal information under the Data Privacy Act of 2012.
Download
Psychiatric Release Of Information Form
A Philippine-compliant legal form authorizing the release of psychiatric and mental health information, ensuring patient privacy protection while facilitating necessary medical information sharing.
Download
Medical Release Of Liability
A Philippine-compliant liability waiver for medical procedures that protects healthcare providers while ensuring patient rights and informed consent.
Download
Medical Release Information
A Philippine-compliant authorization document for the release of medical information, aligned with local data privacy and healthcare regulations.
Download
Photo Release Authorization Form
A Philippine law-compliant authorization form granting permission to use and distribute photographs of an individual, ensuring compliance with local privacy and data protection regulations.
Download
Return To Work Medical Release Form
A Philippine-compliant medical release form documenting an employee's fitness to return to work after medical leave, including necessary clearances and work modifications.
Download
Consent For Release
A Philippine law-governed document authorizing the release and sharing of personal information in compliance with the Data Privacy Act.
Download
Motor Vehicle Record Disclosure And Release Form
A Philippine-compliant form for authorizing and requesting the release of motor vehicle records from the Land Transportation Office (LTO).
Download
Information Release
A Philippine law-governed agreement establishing terms for controlled information sharing between parties, ensuring compliance with local data privacy regulations.
Download
Generic Waiver Form
A Philippine law-compliant document where one party voluntarily waives specific legal rights or claims against another party, providing legal protection and risk management.
Download
Dental X Ray Release Form
A Philippine-compliant consent and authorization form for dental X-ray procedures, ensuring legal and regulatory compliance while protecting patient rights and data privacy.
Download
Consent Form For Release Of Information
A Philippine-compliant legal document authorizing the collection, processing, and sharing of personal information under the Data Privacy Act of 2012.
Download
Caregiver Medical Release Form
A Philippine-compliant legal document authorizing caregivers to make medical decisions and access healthcare information for their care recipients.
Download
Authorization For Release Of Records Form
A Philippine-compliant authorization form for the legal release and transfer of records between parties, adhering to local data privacy laws and regulations.
Download
Authorization For Disclosure
A Philippine law-compliant document authorizing the controlled disclosure of specific information between designated parties while ensuring data privacy protection.
Download
Universal Release Of Information Form
A Philippine-compliant legal form authorizing the release and sharing of personal information, aligned with the Data Privacy Act of 2012.
Download
Transcript Release Authorization Form
A Philippine-compliant authorization form for the release of academic transcripts, meeting local data privacy and educational requirements.
Download
Release Of Financial Obligation Form
A Philippine law-compliant document that formally releases a debtor from their financial obligations to a creditor, providing legal finality to debt settlement.
Download
Publicity Consent Form
A Philippine law-compliant consent form authorizing the use of an individual's image and personal attributes for publicity purposes, incorporating local data privacy requirements.
Download
Patient Release Form
A Philippine-compliant legal document that formalizes patient discharge from medical facilities, including care instructions and liability provisions.
Download
Patient Authorization For Disclosure Of Health Information
A Philippine-compliant authorization form for the disclosure of patient health information, meeting Data Privacy Act requirements.
Download
Authorization To Release Loan Information Form
A Philippine-compliant authorization form for the release of loan information to specified third parties, meeting local banking and data privacy requirements.
Download
Authorization For Release Of Medical Record Information
A Philippine-compliant authorization form for the release of medical records, meeting Data Privacy Act requirements and healthcare regulations.
Download
Release Of Health Information Form
A Philippine-compliant authorization form for the release of protected health information, aligned with the Data Privacy Act and healthcare regulations.
Download
Doctor Release Form To Return To Work
A Philippine-compliant medical certification document authorizing an employee's return to work after medical leave, including any necessary workplace restrictions or accommodations.
Download
Online Medical Consent Form
A Philippines-compliant online medical consent form for documenting patient authorization for medical procedures and treatments in digital format.
Download
Employee Medical Release Form
A Philippine-compliant form authorizing employers to access and handle specific employee medical information while ensuring data privacy protection.
Download
Consent To Disclose Medical Information
A Philippine law-compliant document authorizing the disclosure of specified medical information from one party to another, ensuring compliance with data privacy and healthcare regulations.
Download
Consent Form To Disclose Medical Information
A Philippine-compliant consent form for authorizing the disclosure of patient medical information, aligned with local data privacy laws and healthcare regulations.
Download
Release Of Liability Form For Dental Treatment
A Philippine-law governed liability release form for dental procedures that establishes patient informed consent and protects dental practitioners while ensuring compliance with local healthcare regulations.
Download
Authorization To Release Documents
A Philippine-compliant legal document authorizing the release of specified documents to designated parties, including privacy protections and notarization requirements.
Download
Legal Medical Consent Form
A Philippine-compliant legal document recording patient informed consent for medical procedures, ensuring compliance with local healthcare regulations and protecting both patient and provider rights.
Download
Medical Release Waiver
A Philippine-compliant medical release and consent document that protects healthcare providers while ensuring patient rights and informed consent for medical procedures.
Download
Counseling Release Form
A Philippine-compliant legal document establishing the counseling relationship between mental health professional and client, including service terms, confidentiality, and liability releases.
Download
Student Release Form
A legal document used in Philippine educational institutions to obtain parental/guardian authorization for student activities, compliant with local education and child protection laws.
Download
Promissory Note Release
A Philippine law-governed document that formally releases a debtor from their obligations under a promissory note, providing legal evidence of debt satisfaction.
Download
Patient Disclosure Authorization Form
A Philippine-compliant authorization form for the disclosure of patient medical information, ensuring protected and controlled sharing of healthcare data while maintaining patient privacy rights.
Download
Medication Release Form
A Philippine-compliant legal form authorizing and documenting the release of medication from healthcare providers to patients, ensuring proper dispensing documentation and patient safety.
Download
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
.png)
.png)