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1. Patient Information: Basic details of the patient including full name, Emirates ID, date of birth, contact information, and medical record number
2. Requesting Party Details: Information about the person/entity requesting access to the medical records, including their relationship to the patient if not the patient themselves
3. Information to be Released: Specific description of medical information authorized for release, including date ranges and types of records
4. Purpose of Release: Clear statement of the reason for requesting the medical information
5. Duration of Authorization: Validity period of the authorization and expiry date
6. Release Method: Specification of how the information will be transmitted or accessed
7. Patient Rights Statement: Statement of patient's rights regarding the release of information, including right to revoke authorization
8. Confidentiality Statement: Statement regarding the confidential handling of released information and restrictions on further disclosure
9. Signatures and Attestation: Space for required signatures, including patient/guardian, witness, and healthcare provider representative
1. Guardian Authorization: Additional section for cases where the patient is a minor or legally incapacitated
2. Specific Exclusions: Section to explicitly state any information that should NOT be released
3. Emergency Contact: Optional inclusion of emergency contact information
4. Fee Schedule: Information about any applicable fees for record retrieval and copying, if relevant
5. Third Party Authorization: Additional authorization details when information is to be released to third parties other than the requesting party
1. Schedule A - Types of Medical Records: Detailed checklist of different types of medical records that can be released (e.g., lab results, imaging reports, consultation notes)
2. Schedule B - Authorized Recipients List: List of specific individuals or entities authorized to receive the information, if multiple recipients are involved
3. Appendix 1 - Identity Verification Requirements: Documentation requirements for verifying the identity of the requesting party
4. Appendix 2 - Privacy Policy Summary: Summary of relevant privacy policies and patient rights under UAE law
Healthcare
Medical Insurance
Legal Services
Healthcare Administration
Medical Research
Pharmaceutical
Education (Medical Institutions)
Government Health Authorities
Healthcare Technology
Medical Records Management
Medical Records
Legal
Compliance
Patient Relations
Health Information Management
Quality Assurance
Risk Management
Clinical Administration
Data Protection
Operations
Medical Records Officer
Privacy Officer
Healthcare Administrator
Compliance Manager
Medical Director
Legal Counsel
Data Protection Officer
Patient Relations Manager
Clinical Documentation Specialist
Healthcare Operations Manager
Quality Assurance Manager
Risk Management Officer
Medical Secretary
Health Information Manager
Patient Care Coordinator
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ұԾ’s Security Promise
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