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1. Parties: Identifies all parties involved: the individual whose information will be released (data subject), the organization/person releasing the information, and the recipient(s) of the information
2. Background: Brief context explaining the purpose and necessity of the information release
3. Definitions: Key terms used in the document, including technical or legal terms that need clarification
4. Information to be Released: Specific description of the personal data, records, or information authorized for release
5. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the information will be used
6. Duration of Authorization: Timeframe for which the authorization is valid, including start and expiration dates
7. Rights of the Data Subject: Statement of rights under the Data Privacy Act, including right to withdraw consent
8. Privacy Notice: Statement about how the information will be protected and handled by the recipient
9. Execution: Signature blocks, date, and witness requirements
1. Medical Records Specific Provisions: Additional provisions specific to medical records release, including HIPAA-style protections
2. Electronic Transmission Authorization: Specific authorization for electronic transmission of information and associated risks
3. Third Party Disclosure: Authorization for subsequent disclosure to additional parties if applicable
4. Emergency Contact: Details of emergency contact person who can act on behalf of the data subject
5. Sensitive Personal Information: Special provisions for releasing sensitive personal information as defined by Philippine law
1. Schedule A - Detailed Information List: Itemized list of specific information/documents to be released
2. Schedule B - Authorized Recipients: Complete list of authorized recipients if multiple parties are involved
3. Schedule C - Security Protocols: Detailed security measures and protocols for handling the released information
4. Appendix 1 - Consent Withdrawal Form: Template form for withdrawing consent in the future
Consent
Data Protection Officer
Data Subject
Disclosure
Information
Personal Data
Personal Information
Personal Information Controller
Personal Information Processor
Processing
Recipient
Records
Release
Releasing Party
Sensitive Personal Information
Third Party
Authorization Period
Confidential Information
Data Privacy Act
Information Security Measures
Privacy Notice
Revocation
Security Breach
Transfer
Scope of Information
Purpose of Disclosure
Duration and Expiry
Rights and Obligations
Confidentiality
Data Protection
Information Security
Third Party Disclosure
Liability and Indemnification
Revocation Rights
Governing Law
Data Transfer
Privacy Notice
Emergency Disclosure
Representations and Warranties
Amendment and Modification
Execution and Authentication
Breach Notification
Severability
Healthcare
Education
Financial Services
Insurance
Employment Services
Government Services
Legal Services
Real Estate
Telecommunications
Social Services
Legal
Compliance
Human Resources
Information Security
Records Management
Risk Management
Privacy Office
Operations
Administrative Services
Data Management
Data Protection Officer
Privacy Compliance Manager
Legal Counsel
Human Resources Manager
Medical Records Administrator
Information Security Officer
Compliance Officer
Risk Manager
Records Management Specialist
Privacy Analyst
Operations Manager
Administrative Services Manager
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