Authorization For Disclosure Of Medical Information

Authorization For Disclosure Of Medical Information Template for Denmark

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Key Requirements PROMPT example:

I need an Authorization For Disclosure Of Medical Information under Danish law for transferring patient records from Copenhagen University Hospital to a private clinic in Germany, with specific provisions for GDPR compliance and cross-border data transfer.

Document background

The Authorization For Disclosure Of Medical Information is a crucial document used in Danish healthcare settings when there is a need to share patient medical information with authorized third parties. This document is essential for compliance with both Danish healthcare regulations and EU GDPR requirements, particularly when handling sensitive personal health data. It becomes necessary in various scenarios, such as transferring medical records between healthcare providers, sharing information with insurance companies, or providing medical information for legal proceedings. The authorization must explicitly detail the scope of information to be shared, the duration of the authorization, and the specific purposes for which the information may be used, while ensuring that patient rights under Danish law are protected. This document is particularly important given Denmark's strict data protection requirements and the need to maintain patient confidentiality while facilitating necessary information sharing in the healthcare system.

Suggested Sections

1. Patient Information: Full legal name, date of birth, address, contact information, and any relevant identification numbers including CPR number

2. Healthcare Provider Information: Details of the healthcare provider/facility currently holding the medical information

3. Recipient Information: Details of the person(s) or organization(s) authorized to receive the medical information

4. Scope of Authorization: Specific description of what medical information is authorized for disclosure, including time periods and types of records

5. Purpose of Disclosure: Clear statement of the purpose(s) for which the information may be used

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

7. Rights and Revocation: Statement of the patient's rights, including the right to revoke authorization and how to do so

8. Data Protection Statement: Information about how the data will be protected and handled in accordance with GDPR and Danish law

9. Signatures: Space for patient signature, date, and witness signature if required

Optional Sections

1. Special Categories Authorization: Additional explicit consent for sensitive information such as mental health records, HIV status, or genetic information - include when such sensitive information is part of the disclosure

2. Third Party Authorization: Section for cases where the authorization is being signed by someone other than the patient (e.g., legal guardian, power of attorney) - include when relevant

3. International Transfer Notice: Additional information and consent for cases where medical information will be transferred outside the EU/EEA - include when applicable

4. Emergency Contact: Details of emergency contact person - include when requested by receiving party or when relevant to the purpose of disclosure

5. Language Declaration: Statement confirming that the patient understands the language in which the authorization is written - include when the patient's primary language is not Danish or English

Suggested Schedules

1. Schedule A - Types of Medical Information: Detailed checklist of specific types of medical information to be disclosed (e.g., test results, diagnoses, treatments, medications)

2. Schedule B - Approved Recipients List: If multiple recipients are authorized, detailed list with full contact information for each

3. Appendix 1 - Revocation Form: Standard form for revoking the authorization if needed

4. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how the disclosed information will be handled and protected

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

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Insurance

Legal Services

Public Administration

Medical Research

Pharmaceutical

Occupational Health

Education (Medical Institutions)

Social Services

Healthcare Technology

Relevant Teams

Legal

Compliance

Medical Records

Patient Services

Data Protection

Healthcare Administration

Risk Management

Information Security

Clinical Operations

Human Resources

Quality Assurance

Privacy

Relevant Roles

Medical Records Administrator

Privacy Officer

Healthcare Compliance Manager

Medical Secretary

Legal Counsel

Data Protection Officer

Healthcare Administrator

Insurance Claims Manager

Clinical Research Coordinator

Human Resources Manager

Occupational Health Manager

Patient Services Coordinator

Medical Office Manager

Healthcare Legal Advisor

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