The Release of Information Request Form is a crucial document used in India when one party needs to formally request and receive authorization to access specific information about an individual from another party. This form is essential for compliance with Indian privacy laws, particularly the Digital Personal Data Protection Act 2023, and is commonly used in healthcare facilities, educational institutions, and financial organizations. The document typically includes detailed identification of all parties involved, specific information being requested, purpose of the request, duration of authorization, and necessary signatures. It serves as both a request mechanism and a record of authorization, protecting the rights of information subjects while facilitating necessary information sharing. The form must be carefully structured to ensure all legal requirements are met while remaining accessible and understandable to all parties involved.
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1. Requestor Information: Details of the person/entity requesting the information, including full name, contact details, and relationship to the subject
2. Subject Information: Details of the person whose information is being requested, including full name, date of birth, contact information, and any relevant identification numbers
3. Information Requested: Specific description of the information being requested, including date ranges and types of records
4. Purpose of Request: Clear statement of why the information is being requested and how it will be used
5. Authorization Statement: Formal declaration authorizing the release of information, including any limitations or restrictions
6. Duration of Authorization: Specification of how long the authorization remains valid
7. Rights Statement: Statement of the subject's rights regarding the information release, including right to revoke
8. Signature Block: Space for signatures, dates, and witness information if required
1. Urgent Request Indicator: Additional section for marking urgent requests with justification, used when expedited processing is needed
2. Third Party Authorization: Used when someone other than the subject is authorized to receive the information
3. Specific Restrictions: Section for indicating any specific parts of the information that should NOT be released
4. Electronic Delivery Authorization: Optional section for authorizing electronic transmission of information, including email consent
5. Fee Agreement: Section acknowledging any applicable fees for information release, used when charges apply
1. List of Requested Documents: Detailed checklist of specific documents or information types being requested
2. Identity Verification Documents: List of acceptable identification documents and copies attached
3. Fee Schedule: If applicable, breakdown of charges for different types of information release
4. Authorization Revocation Form: Template form for revoking the authorization if needed in the future
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Relevant legal definitions
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Relevant Industries
Healthcare
Education
Financial Services
Insurance
Legal Services
Government Services
Banking
Human Resources
Telecommunications
Social Services
Relevant Teams
Legal
Compliance
Medical Records
Information Security
Privacy
Human Resources
Patient Services
Data Protection
Administrative Services
Regulatory Affairs
Relevant Roles
Privacy Officer
Compliance Manager
Medical Records Administrator
Legal Counsel
Data Protection Officer
Healthcare Administrator
Human Resources Manager
Information Security Officer
Records Manager
Admissions Officer
Financial Services Administrator
Patient Services Coordinator
Regulatory Compliance Specialist
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