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Authorization Letter For Medical Records
"I need an Authorization Letter For Medical Records to allow my insurance company to access my medical history from Singapore General Hospital for a claim related to my surgery in March 2025, with the authorization valid for 6 months."
1. Author Information: Full name, NRIC/Passport number, contact details of person giving authorization
2. Patient Information: Full name, NRIC/Passport number, date of birth if different from author
3. Healthcare Provider Details: Name and address of medical facility holding the records
4. Scope of Authorization: Specific medical records being authorized for release
5. Recipient Information: Details of person/entity authorized to receive records
6. Duration: Validity period of the authorization
7. Declaration: Statement of consent and understanding
1. Purpose Statement: Specific reason for requesting records, used when required by recipient
2. Proxy Authorization: Additional section when author is acting on behalf of patient
3. Confidentiality Statement: Additional privacy protection requirements and restrictions on use
1. Identity Verification Documents: Copy of NRIC/Passport of authorizing person
2. Proof of Relationship Documentation: Required when author is not the patient (e.g., birth certificate, marriage certificate)
3. Legal Authority Documentation: Power of attorney, court orders, or other legal documents establishing authority to request records
Authors
Protected Health Information
Healthcare Provider
Authorized Representative
Personal Data
Patient
Authorizing Party
Recipient
Authorization Period
Confidential Information
Healthcare Institution
Medical Information
Treatment Records
Health Information
Disclosure
Release Authorization
Legal Representative
Next of Kin
Personal Particulars
NRIC/Passport Number
Consent
Scope of Release
Duration
Confidentiality
Data Protection
Purpose of Disclosure
Revocation Rights
Liability Release
Verification of Identity
Representation and Authority
Third Party Access
Information Accuracy
Transfer Restrictions
Records Handling
Privacy Protection
Expiration
Medical Emergency Provisions
Further Disclosure Restrictions
Governing Law
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