Consent For Medical Records Release Form

Consent For Medical Records Release Form for Nigeria

Consent For Medical Records Release Form Template for Nigeria

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What is a Consent For Medical Records Release Form?

The Consent For Medical Records Release Form is a critical document used in Nigerian healthcare settings when there is a need to transfer medical records from one party to another. This form becomes necessary when patients need to share their medical information with new healthcare providers, insurance companies, legal representatives, or other authorized parties. The document must comply with the National Health Act 2014 and the Nigeria Data Protection Regulation (NDPR) 2019, which set strict requirements for handling sensitive health information. The form includes specific consent provisions, details of information to be released, time limitations, and clear statements of patient rights. It serves as a legal safeguard for both healthcare providers and patients, ensuring proper authorization and documentation of medical records transfer while protecting patient privacy rights under Nigerian law.

What sections should be included in a Consent For Medical Records Release Form?

1. Patient Information: Complete identification details of the patient including full name, date of birth, address, and contact information

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

3. Recipient Information: Details of the person or entity authorized to receive the medical records

4. Information to be Released: Specific description of medical records to be released, including date ranges and types of information

5. Purpose of Disclosure: Statement of the reason for requesting the medical records release

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

7. Rights and Notices: Statement of patient's rights including right to revoke authorization and any limitations

8. Signatures and Date: Space for patient or legal representative signature, date, and witness signatures if required

What sections are optional to include in a Consent For Medical Records Release Form?

1. Special Authorization for Sensitive Information: Additional specific consent for release of sensitive information such as HIV status, mental health records, or genetic information. Include when such sensitive information might be part of the records

2. Legal Representative Authorization: Section for legal representative details and authority documentation. Include when the person authorizing is not the patient

3. Translation Certificate: Certificate of translation if the form is provided in multiple languages. Include when the patient's primary language is not English

4. Electronic Records Transfer Authorization: Specific consent for electronic transfer of records. Include when records will be transferred electronically

What schedules should be included in a Consent For Medical Records Release Form?

1. Schedule A - Types of Medical Records: Detailed checklist of specific types of medical records that can be released

2. Schedule B - Fee Schedule: List of applicable fees for records release, if any

3. Appendix 1 - Patient Rights Notice: Detailed explanation of patient rights regarding medical records under Nigerian law

4. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how the 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

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Insurance

Legal Services

Pharmaceuticals

Medical Research

Education

Government Health Services

Healthcare Technology

Public Health

Relevant Teams

Medical Records

Legal

Compliance

Privacy

Patient Services

Health Information Management

Quality Assurance

Risk Management

Operations

Clinical Documentation

Relevant Roles

Medical Records Officer

Healthcare Administrator

Compliance Officer

Privacy Officer

Medical Director

Legal Counsel

Healthcare Operations Manager

Data Protection Officer

Patient Services Coordinator

Clinical Documentation Specialist

Health Information Manager

Quality Assurance Manager

Risk Management Officer

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Info Release Form

A Nigerian law-compliant document authorizing the controlled release of information between parties, incorporating NDPR requirements and data protection principles.

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Download a Standard Template

What is a Consent For Medical Records Release Form?

What sections should be included in a Consent For Medical Records Release Form?

What sections are optional to include in a Consent For Medical Records Release Form?

What schedules should be included in a Consent For Medical Records Release Form?

Authors

Alex Denne

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