Medical History Request Form

Medical History Request Form for Switzerland

Medical History Request Form Template for Switzerland

A standardized form designed for requesting medical history records in compliance with Swiss federal and cantonal healthcare regulations. This document facilitates the secure transfer of patient medical information between authorized parties while ensuring compliance with Swiss data protection laws, particularly the Federal Act on Data Protection (FADP) and the Federal Act on Electronic Patient Records (EPRA). The form includes comprehensive sections for patient identification, scope of request, consent mechanisms, and data protection notices, ensuring proper handling of sensitive medical information within the Swiss healthcare system.

Your data doesn't train Genie's AI

You keep IP ownership of your information

Generate a Bespoke Document

1. Select your governing law:

2. Enter your key requirements:

3. Create your document to edit, review or download

Download a Standard Template

Get our Switzerland-compliant Medical History Request Form

4.6 / 5

4.8 / 5

Alternatively: Run an advanced review of an existing
Medical History Request Form

Let ��Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.

What is a Medical History Request Form?

The Medical History Request Form is a crucial document used in the Swiss healthcare system to facilitate the authorized transfer of patient medical records between healthcare providers, institutions, or to patients themselves. This form becomes necessary when medical history information needs to be shared for purposes such as continuing care, seeking second opinions, insurance claims, or legal proceedings. It must comply with strict Swiss data protection laws, including the Federal Act on Data Protection (FADP) and relevant cantonal regulations. The document includes specific provisions for patient consent, data protection notices, and authentication requirements, ensuring that sensitive medical information is handled appropriately and securely. The form is designed to be comprehensive yet clear, allowing for efficient processing while maintaining the high standards of Swiss healthcare privacy requirements.

What sections should be included in a Medical History Request Form?

1. Patient Information: Essential personal details including full name, date of birth, address, contact information, and insurance details

2. Request Authorization: Declaration of who is requesting the medical history (patient themselves, authorized representative, or healthcare provider) with verification details

3. Scope of Request: Specific medical information being requested, including time period and types of records

4. Purpose of Request: Clear statement of why the medical history is being requested (e.g., continuing treatment, second opinion, insurance purposes)

5. Healthcare Provider Details: Information about the healthcare providers from whom records are being requested

6. Data Protection Notice: Information about how the requested data will be handled, stored, and protected in compliance with Swiss law

7. Consent Declaration: Explicit patient consent for the release of medical information, including specific mentions of sensitive data categories

8. Authentication: Space for signature, date, and any required witness or notary confirmations

What sections are optional to include in a Medical History Request Form?

1. Urgent Request Designation: Additional section to be included when the medical history is needed urgently, specifying reasons and required timeframe

2. Third Party Authorization: To be included when someone other than the patient is authorized to request or receive the medical history

3. Research Consent: Optional section for cases where the medical history might also be used for research purposes, requiring additional specific consent

4. International Transfer Notice: Required when medical history might be transferred outside Switzerland, including additional data protection information

5. Insurance Company Authorization: Specific section for insurance-related requests, including relevant policy numbers and coverage details

What schedules should be included in a Medical History Request Form?

1. List of Required Documents: Checklist of specific medical documents being requested (e.g., consultation notes, test results, imaging reports)

2. Identity Verification Documents: List of acceptable identification documents and requirements for authentication

3. Fee Schedule: Information about any applicable fees for requesting and processing medical records

4. Provider Contact List: Contact details and submission instructions for relevant healthcare providers

5. Privacy Policy: Detailed information about data protection measures and patient rights under Swiss 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

Cost

Free to use

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Insurance

Medical Research

Healthcare Administration

Legal Services

Data Protection

Medical Records Management

Clinical Research

Pharmaceutical

Relevant Teams

Medical Records

Compliance

Legal

Patient Services

Healthcare Administration

Data Protection

Clinical Operations

Insurance Processing

Quality Assurance

Medical Information

Relevant Roles

Medical Records Administrator

Healthcare Privacy Officer

Compliance Manager

Medical Secretary

Clinical Administrator

Healthcare Provider

Medical Director

Insurance Claims Manager

Legal Counsel

Data Protection Officer

Patient Services Coordinator

Clinical Research Coordinator

Healthcare Operations Manager

Find the exact document you need

No matches found.

Prison Release Form

A Swiss legal document that formalizes prisoner release conditions and obligations under federal and cantonal law.

��������Ƶ

How Cambridge United Uses ��������Ƶ to Speed Up Player Signings and Slash Legal Costs

Generate a Bespoke Document

Download a Standard Template

What is a Medical History Request Form?

What sections should be included in a Medical History Request Form?

What sections are optional to include in a Medical History Request Form?

What schedules should be included in a Medical History Request Form?

Authors

Alex Denne

Jurisdiction

Publisher

Document Type

Sector

Cost

Find the exact document you need

Prison Release Form

Tenant Release Form

Release Of Health Information Form

Consent Form For Social (Media)

Promissory Note Release

Form Medical Record

Authorization To Disclose

Participant Release Form

Video Release Consent Form

Customer Release Form

Termination Of Account Letter

Photography Consent Form

Medical Records Form

Release Request Form

Pre Employment Background Check Consent Form

New Release Form

Digital Release Form

Release Letter Form

Protected Health Information Form

Media Permission Form

Actor Release Form

Share Medical Information Form

Records Request Form Medical

Patient Record Request Form

Physician Release To Return To Work Form

Authorization For Use Disclosure Of Health Information

Fingerprint Release Form

Basic Media Release Form

Patient Medical Records Request Form

Medical History Consent Form

General Photo Release Form

Permission To Release Information Form

Real Estate Release Form

Release And Discharge Letter

Medical Records Request Form

Health Record Request Form

Generic Release Of Information Form

Data Release Consent Form

Permission Medical Consent Form For Adults

�ұ�Ծ���’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security:

Use Cases

Generate Legal Docs Free

��Ƶ

How Cambridge United Uses ��Ƶ to Speed Up Player Signings and Slash Legal Costs

�ұ�Ծ��’s Security Promise