Consent To Release Medical Information Form - United Arab Emirates

Consent To Release Medical Information Form for United Arab Emirates

Consent To Release Medical Information Form Template for United Arab Emirates

This document serves as a formal authorization mechanism for the release of medical information in the United Arab Emirates, complying with Federal Law No. 2 of 2019 and related healthcare data protection regulations. It enables healthcare providers to share specified medical records with designated recipients while protecting patient privacy rights and maintaining legal compliance. The form includes comprehensive patient identification, specific scope of information to be released, intended recipients, purpose of disclosure, and duration of authorization, all structured to meet UAE healthcare information handling requirements.

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What is a Consent To Release Medical Information Form?

The Consent To Release Medical Information Form is a critical document used in UAE healthcare settings to facilitate the authorized sharing of patient medical information while ensuring compliance with UAE Federal Law No. 2 of 2019 and related healthcare data protection regulations. This document becomes necessary when medical information needs to be shared between healthcare providers, released to insurance companies, or disclosed to other authorized parties. It serves as a legal safeguard for both healthcare providers and patients, ensuring that sensitive medical information is only released with explicit patient consent and for specified purposes. The form must be completed before any protected health information can be shared, and it includes specific provisions for data protection as required by UAE law, including scope of information to be released, duration of authorization, and recipient details.

What sections should be included in a Consent To Release Medical Information Form?

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

2. Healthcare Provider Details: Information about the healthcare provider/facility currently holding the medical records

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: Clear statement of the reason for releasing the medical information

6. Duration of Authorization: Specific timeframe for which the authorization is valid

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

8. Signatures and Date: Space for patient or legal representative signature, date, and witness signature if required

What sections are optional to include in a Consent To Release Medical Information Form?

1. Legal Representative Authorization: Additional section when the consent is being given by a legal representative rather than the patient directly

2. Specific Exclusions: Section to explicitly state any parts of the medical record that should NOT be released

3. Electronic Transmission Authorization: Additional authorization specifically for electronic transmission of records, if applicable

4. Translation Confirmation: For non-Arabic speaking patients, confirmation that the form has been explained in their preferred language

5. Emergency Contact Information: Additional contact information section for urgent matters related to the information release

What schedules should be included in a Consent To Release Medical Information Form?

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

2. Schedule B - Authorized Recipients List: If multiple recipients are authorized, detailed list with specific permissions for each

3. Schedule C - Fee Schedule: If applicable, breakdown of any administrative fees associated with the release of medical information

4. Appendix 1 - Patient Rights Summary: Detailed explanation of patient rights regarding medical information in accordance with UAE law

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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What is a Consent To Release Medical Information Form?

What sections should be included in a Consent To Release Medical Information Form?

What sections are optional to include in a Consent To Release Medical Information Form?

What schedules should be included in a Consent To Release Medical Information Form?

Authors

Alex Denne

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