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Medical Release Consent Form Template for England and Wales

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Key Requirements PROMPT example:

Medical Release Consent Form

"I need a Medical Release Consent Form for my private clinic to share patient records with a research institution, ensuring compliance with GDPR and including specific provisions for anonymizing data before transfer."

Document background
The Medical Release Consent Form serves as a critical document in healthcare information management within England and Wales. It is required whenever patient medical information needs to be shared with third parties, whether for continued care, insurance purposes, legal proceedings, or research. The form ensures compliance with UK data protection laws and medical practice regulations, protecting both the healthcare provider and the patient's interests. It establishes clear parameters for what information can be shared, with whom, and for how long.
Suggested Sections

1. Patient Information: Full name, date of birth, NHS number, contact details and other identifying information of the patient

2. Purpose of Release: Clear statement of the specific purpose(s) for which medical information is being released

3. Information to be Released: Detailed description of the specific medical information authorized for release, including time periods and types of records

4. Recipient Details: Complete information about who is authorized to receive the medical information, including organization name and contact details

5. Duration of Consent: Specified time period for which the consent remains valid, including start and end dates if applicable

6. Declaration and Signature: Patient's confirmation of understanding and explicit consent, including signature, date, and witness details if required

Optional Sections

1. Emergency Contacts: Secondary contacts to be reached if patient is unavailable - recommended for ongoing care arrangements

2. Specific Exclusions: Explicit list of information that the patient does not authorize to be shared or released

3. Third Party Authorization: Authorization for specified individuals to act on patient's behalf, including details of their powers and limitations

4. Capacity Assessment: Assessment of patient's mental capacity to provide consent, required when there are concerns about capacity

Suggested Schedules

1. Information Sheet: Detailed explanation of how the released information will be used, stored, protected, and eventually disposed of

2. Privacy Notice: GDPR-compliant privacy information detailing data protection rights and procedures

3. Withdrawal Form: Template form for withdrawing consent at a later date if the patient chooses to do so

4. Rights Information: Summary of patient's rights under relevant legislation including Data Protection Act 2018 and UK GDPR

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions
























Clauses
























Industries

Data Protection Act 2018: Primary UK legislation governing personal data processing and protection, implementing GDPR principles into UK law

UK GDPR: Post-Brexit version of EU GDPR, setting out key principles for processing personal data, including special category health data

Access to Health Records Act 1990: Legislation providing rights of access to health records, particularly relevant for deceased patients' records

Mental Capacity Act 2005: Law governing decision-making for people who may lack capacity to consent, including medical decisions

Human Rights Act 1998: Legislation protecting fundamental rights including privacy and confidentiality in medical contexts

Health and Social Care Act 2012: Framework legislation for healthcare delivery and information sharing in England

Medical Act 1983: Core legislation governing medical practice and professional standards in the UK

NHS Act 2006: Primary legislation establishing NHS functions and responsibilities including information governance

Caldicott Principles: Guidelines for handling patient-identifiable information in healthcare settings, including principles for information sharing

GMC Confidentiality Guidance: Professional guidelines from the General Medical Council on managing patient confidentiality and information sharing

BMA Guidelines: British Medical Association's professional guidance on medical records and consent

NHS Digital Guidelines: Technical and operational guidelines for handling healthcare information within the NHS framework

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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