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Release Of Information Form Mental Health Template for England and Wales

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Key Requirements PROMPT example:

Release Of Information Form Mental Health Template

I need a Release Of Information Form Mental Health Template for transferring patient records from our London clinic to a specialist treatment facility in Manchester, with specific provisions for ongoing therapy notes and medication history over the next six months starting January 2025.

Document background
The Release Of Information Form Mental Health Template is a critical document used in England and Wales when there is a need to share confidential mental health information between healthcare providers and authorized recipients. This template ensures compliance with UK data protection laws and mental health regulations while protecting patient privacy rights. It is particularly important in cases where coordinated care is required or when mental health information needs to be shared for legal, educational, or treatment purposes. The form includes specific provisions for consent, information scope, and duration of authorization.
Suggested Sections

1. Patient Information: Basic identifying information about the patient including name, date of birth, address, and contact details

2. Authorization Statement: Clear statement confirming the patient's consent to release specified mental health information

3. Purpose of Disclosure: Specific reason for information release, including intended use of the information

4. Information to be Released: Detailed specification of which mental health records are to be shared, including date ranges and types of records

5. Duration of Authorization: Time period for which the authorization is valid, including start and end dates

6. Recipient Information: Details of who will receive the information, including organization name, contact person, address and contact details

7. Signature Block: Space for patient/guardian signature, date, and witness signature if required

Optional Sections

1. Special Conditions: Section for specifying any restrictions or limitations on how the information can be used or shared

2. Third Party Authorization: Section for cases where someone other than the patient is authorized to request or receive information

3. Emergency Contact: Section for including details of emergency contact person and their relationship to the patient

4. Capacity Assessment: Section for documenting assessment of patient's capacity to consent when relevant

Suggested Schedules

1. Privacy Notice: Detailed information about how personal data will be handled in compliance with UK GDPR and Data Protection Act 2018

2. Rights Information: Summary of patient rights regarding their information under relevant mental health and data protection legislation

3. Revocation Instructions: Detailed instructions on how to withdraw consent and the process for revoking this authorization

4. Legal Framework Reference: Summary of relevant legislation and regulations governing the release of mental health information

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 that implements and supplements the UK GDPR, providing framework for data protection and privacy laws in the UK

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

Mental Health Act 1983: Principal legislation governing mental health care in England and Wales, including provisions for information handling and patient rights

Mental Capacity Act 2005: Framework for making decisions on behalf of people who lack capacity, including handling of their personal information

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

Human Rights Act 1998: Incorporates European Convention rights into UK law, including right to privacy and family life (Article 8)

Health and Social Care Act 2012: Legislation organizing healthcare provision in England, including information governance requirements

Caldicott Principles: Set of principles governing handling of patient information in the NHS, including confidentiality and information sharing

NHS Confidentiality Code of Practice: Guidance for NHS staff on handling patient information, ensuring confidentiality and appropriate information sharing

Professional Regulatory Standards: Standards set by professional bodies (GMC, NMC) regarding confidentiality and information handling in healthcare

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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