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1. Parties: Identification of the patient (data subject) and the healthcare provider/facility currently holding the medical information
2. Background: Brief context explaining the purpose of this authorization
3. Definitions: Key terms used in the authorization, including 'Medical Information', 'Authorized Recipients', 'Processing', etc.
4. Scope of Authorization: Detailed description of what medical information is authorized for disclosure
5. Authorized Recipients: Identity and contact details of persons/entities authorized to receive the medical information
6. Purpose of Disclosure: Specific purpose(s) for which the medical information may be used
7. Duration of Authorization: Time period for which the authorization is valid
8. Rights of the Patient: Statement of patient's rights including right to revoke authorization and data subject rights under GDPR
9. Data Protection Provisions: Specific provisions ensuring compliance with GDPR and German data protection laws
10. Execution: Signature blocks and date of authorization
1. Special Categories of Data: Additional provisions for sensitive data categories (e.g., genetic data, HIV status) - include when such data is part of the disclosure
2. Third Party Authorization: Additional provisions when authorization is given by a legal representative - include for minors or individuals lacking capacity
3. International Transfer Provisions: Additional provisions for transfers outside the EU/EEA - include when recipients are located outside these areas
4. Emergency Provisions: Special provisions for emergency situations - include when authorization needs to cover emergency circumstances
5. Cost Provisions: Details about any costs associated with the information disclosure - include when relevant charges apply
1. Schedule 1 - Detailed Description of Medical Information: Itemized list of specific medical records, time periods, and types of information covered by the authorization
2. Schedule 2 - Authorized Recipients List: Detailed information about all authorized recipients, including contact details and role
3. Schedule 3 - Revocation Form: Standard form for revoking the authorization
4. Schedule 4 - Privacy Notice: Detailed privacy notice explaining how the medical information will be handled
5. Appendix A - Proof of Identity: Requirements and acceptable forms of identity verification
Healthcare
Insurance
Medical Research
Pharmaceuticals
Healthcare Technology
Legal Services
Public Health
Occupational Health
Medical Education
Healthcare Consulting
Legal
Compliance
Medical Records
Data Protection
Patient Services
Clinical Operations
Quality Assurance
Healthcare Administration
Information Governance
Risk Management
Medical Director
Healthcare Administrator
Data Protection Officer
Compliance Manager
Medical Records Manager
Healthcare Privacy Officer
Legal Counsel
Clinical Director
Insurance Claims Manager
Research Coordinator
Medical Secretary
Patient Services Coordinator
Healthcare Operations Manager
Quality Assurance Manager
Medical Information Officer
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