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1. Parties: Identifies all relevant parties: the patient (data subject), the healthcare provider releasing the information, and the recipient of the information
2. Background: Brief context explaining the purpose and necessity of the medical records release
3. Definitions: Key terms used in the document including 'medical records', 'personal information', 'health information', and other relevant terminology
4. Information to be Released: Detailed specification of exactly which medical records and information are authorized for release, including date ranges and types of records
5. Purpose of Release: Clear statement of the specific purpose(s) for which the information is being released
6. Duration of Authorization: Timeframe for which the authorization is valid
7. Rights and Responsibilities: Statement of the rights of the patient including right to revoke authorization, and responsibilities of each party
8. Privacy and Confidentiality: Provisions regarding the confidential handling of the released information and compliance with POPIA requirements
9. Signature and Declaration: Formal authorization signatures, dates, and declarations of understanding
1. Electronic Records Transfer: Include when records will be transferred electronically, specifying security measures and transfer protocols
2. Third Party Authorization: Include when someone other than the patient is authorized to request or receive the records
3. Minor Patient Provisions: Include when the medical records pertain to a minor, addressing parental/guardian consent requirements
4. Special Categories of Information: Include when releasing sensitive information such as HIV status, mental health records, or genetic information
5. Cost and Payment: Include when there are fees associated with the release of records
1. Schedule A - Detailed Record List: Itemized list of specific medical records to be released, including dates and record types
2. Schedule B - Consent Forms: Additional consent forms required for specific types of information (e.g., HIV status, mental health records)
3. Schedule C - Fee Schedule: If applicable, breakdown of costs associated with record release
4. Appendix 1 - Patient Rights Summary: Summary of patient rights regarding medical records under South African law
5. Appendix 2 - Authorization Revocation Form: Form for revoking the authorization if needed in the future
Medical Records
Personal Information
Special Personal Information
Healthcare Provider
Authorized Recipient
Data Subject
Release Authorization
Healthcare Facility
Consent
Medical Information
Confidential Information
Electronic Health Records
Health Information Exchange
Data Protection Officer
Information Officer
Treatment
Data Processing
Data Transfer
Healthcare Operations
Minor Patient
Legal Guardian
Third Party
Revocation
Professional Designation
Medical Practice
Record Custodian
Disclosure
Authorization Period
Security Safeguards
Consent
Information Disclosure
Confidentiality
Privacy Protection
Data Security
Access Rights
Duration and Expiry
Revocation Rights
Information Transfer
Record Handling
Third Party Disclosure
Electronic Records
Liability
Compliance
Data Protection
Patient Rights
Healthcare Provider Obligations
Record Retention
Dispute Resolution
Healthcare
Medical Insurance
Legal Services
Healthcare Technology
Medical Research
Pharmaceutical
Occupational Health
Public Health
Medical Records
Compliance
Legal
Privacy
Healthcare Administration
Patient Services
Information Management
Clinical Documentation
Risk Management
Quality Assurance
Medical Records Administrator
Healthcare Facility Manager
Compliance Officer
Privacy Officer
Medical Practice Manager
Healthcare Administrator
Legal Counsel
Data Protection Officer
Medical Secretary
Healthcare Operations Manager
Clinical Documentation Specialist
Medical Information Officer
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