Generic Release Of Information Form for the United States

Generic Release Of Information Form Template for United States

A Generic Release of Information Form is a legal document used in the United States that authorizes the disclosure of specific information from one party to another. This document complies with federal privacy laws including HIPAA, FERPA, and GLBA where applicable, as well as state-specific privacy regulations. It serves as a formal consent mechanism to share personal, medical, educational, or financial information while protecting the rights of the information owner and establishing clear parameters for information sharing.

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What is a Generic Release Of Information Form?

The Generic Release of Information Form is essential when there's a need to legally and securely share personal information between parties in the United States. This document is commonly used across various sectors including healthcare, education, and financial services, ensuring compliance with federal and state privacy laws. The form typically includes specific details about what information can be shared, with whom, for what purpose, and for how long. It's designed to protect both the information owner's rights and the receiving party's obligations while maintaining clear documentation of consent.

What sections should be included in a Generic Release Of Information Form?

1. Parties Information: Details of the individual authorizing release and the entity/person receiving information

2. Information to be Released: Specific description of what information is authorized for release

3. Purpose of Release: Clear statement of why the information is being released

4. Duration: Time period for which the authorization is valid

5. Authorization Statement: Formal statement of consent to release information

6. Signature Block: Space for date and signatures of authorizing party

What sections are optional to include in a Generic Release Of Information Form?

1. Specific Restrictions: Any limitations on the release of information - used when partial access to information is granted

2. HIPAA Compliance Statement: Specific HIPAA privacy notices and rights - used when medical information is involved

3. Revocation Rights: Information about right to withdraw consent - used when required by specific regulations or for ongoing authorizations

4. Re-disclosure Notice: Statement about potential further sharing of information - used when information might be shared beyond initial recipient

What schedules should be included in a Generic Release Of Information Form?

1. Schedule A - Detailed Information List: Itemized list of specific records/information to be released

2. Schedule B - Authorized Recipients: List of specific individuals/entities authorized to receive information when multiple recipients are involved

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

Cost

Free to use

Relevant legal definitions

Information Owner
Authorized Representative
Protected Information
Recipient
Authorized Use
Confidential Information
Disclosure
Release Authorization
Effective Date
Expiration Date
Personal Information
Re-disclosure
Revocation
Third Party
Written Notice
Consent
Protected Health Information

Clauses

Authorization and Consent
Scope of Information
Purpose of Disclosure
Duration and Expiration
Revocation Rights
Re-disclosure Restrictions
Information Protection
Confidentiality
Rights of the Information Owner
Recipient Obligations
Liability and Indemnification
Governing Law
Signatures and Authentication
Notices
Third Party Rights
Severability
Entire Agreement
Privacy Protection
Record Keeping

Relevant Industries

Healthcare
Education
Financial Services
Legal Services
Human Resources

Relevant Teams

Legal
Compliance
Human Resources
Medical Records
Information Technology

Relevant Roles

Privacy Officer
Records Manager
Compliance Manager
Human Resources Director
Medical Records Administrator

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What is a Generic Release Of Information Form?

What sections should be included in a Generic Release Of Information Form?

What sections are optional to include in a Generic Release Of Information Form?

What schedules should be included in a Generic Release Of Information Form?

Authors

Alex Denne

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