Consent To Release Medical Information Form Template for Saudi Arabia

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Key Requirements PROMPT example:

Consent To Release Medical Information Form

"I need a Consent To Release Medical Information Form under Saudi Arabian law for a multi-hospital healthcare network, allowing secure sharing of patient records between facilities while ensuring compliance with both digital health regulations and traditional paper-based requirements."

Document background

The Consent To Release Medical Information Form is a critical document in Saudi Arabian healthcare operations, designed to facilitate the secure and compliant transfer of patient medical information. This document is essential when medical records need to be shared between healthcare providers, released to insurance companies, or disclosed to other authorized parties. It ensures compliance with Saudi Arabia's Health Law, Personal Data Protection Law, and relevant Ministry of Health regulations. The form must be used whenever patient medical information needs to be released to third parties, protecting both the healthcare provider's legal obligations and the patient's rights. It includes comprehensive details about the scope of information to be released, authorization period, and specific consents required under Saudi law, particularly for sensitive medical information.

Suggested Sections

1. Patient Information: Full identification details of the patient including name, date of birth, medical record number, and contact information

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

3. Recipient Information: Details of the person or entity to whom the medical information will be released

4. Information to be Released: Specific description of medical information authorized for release, including date ranges and types of records

5. Purpose of Disclosure: Statement of the reason for releasing the medical information

6. Duration of Authorization: Specification of how long the authorization remains valid

7. Rights and Notices: Statement of patient's rights including right to revoke authorization and any limitations

8. Signatures and Attestation: Space for patient or authorized representative signature, date, and witness signatures if required

Optional Sections

1. Specific Sensitive Information Authorization: Additional authorization section for sensitive information like mental health records, HIV status, or genetic testing - required only if such information is included in the release

2. Legal Representative Authorization: Section for cases where someone other than the patient is authorizing the release, including proof of authority

3. Translation Certification: Required when the form is provided in multiple languages or when a translator is involved in the consent process

4. Emergency Contact Information: Optional section for including emergency contact details, particularly relevant for ongoing care situations

Suggested Schedules

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

2. Schedule B - Fee Schedule: If applicable, list of any fees associated with the release of medical records

3. Appendix 1 - Glossary of Medical Terms: Optional glossary explaining medical terminology used in the form in plain language

4. Appendix 2 - Patient Rights Summary: Summary of patient rights regarding medical information in accordance with Saudi Arabian 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

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Insurance

Legal Services

Healthcare Technology

Pharmaceutical

Medical Research

Occupational Health

Education (Medical Institutions)

Government Health Services

Social Services

Relevant Teams

Legal

Compliance

Medical Records

Patient Services

Health Information Management

Risk Management

Quality Assurance

Operations

Administrative Services

Clinical Documentation

Relevant Roles

Medical Records Officer

Healthcare Administrator

Compliance Officer

Legal Counsel

Privacy Officer

Medical Director

Insurance Claims Processor

Healthcare Facility Manager

Patient Relations Coordinator

Clinical Documentation Specialist

Health Information Manager

Quality Assurance Manager

Risk Management Officer

Medical Secretary

Healthcare Operations Manager

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