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1. Authoriser Details: Full name, address, date of birth, contact information of person authorising release
2. Records Holder Information: Details of organization/person holding the records
3. Records Description: Specific description of records to be released
4. Recipient Information: Details of person/organization authorized to receive records
5. Purpose of Release: Stated purpose for which records are being released
6. Duration of Authorization: Time period for which authorization remains valid
7. Signature and Date: Authorization signature and dating requirements
1. Third Party Authorization: Additional authorization requirements when records are to be released to someone other than the subject
2. Specific Exclusions: Details of any records specifically excluded from release
3. Witness Requirements: Witness signature requirements when required by specific circumstances or record types
1. Identity Verification Documents: Copies of required ID documents to be attached
2. Power of Attorney: Documentation proving authority to act on behalf of another person
3. Specific Records List: Detailed inventory of records to be released when extensive
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