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1. Patient Information: Complete identification details of the patient including full name, date of birth, NHI number, and contact information
2. Healthcare Provider Details: Information about the healthcare provider/facility currently holding the medical records, including name, address, and contact information
3. Recipient Information: Details of the person or organization authorized to receive the medical records, including name, address, and contact information
4. Information to be Released: Specific description of what medical information is authorized for release, including date ranges and types of records
5. Purpose of Release: Clear statement of the reason for releasing the medical information
6. Duration of Authorization: Specification of how long the authorization remains valid
7. Patient Rights Statement: Statement of patient's rights regarding the authorization, including right to revoke and any limitations
8. Privacy Statement: Statement regarding privacy obligations and handling of information under NZ Privacy Act 2020
9. Signatures: Space for patient or authorized representative signature, date, and witness if required
1. Mental Health Records Authorization: Additional specific authorization for release of mental health records, required when mental health information is included
2. Sensitive Information Authorization: Special authorization for sensitive information such as HIV status, genetic testing, or substance abuse treatment
3. Emergency Contact Information: Details of emergency contact person, recommended when records are being transferred for ongoing care
4. Cost Information: Information about any fees associated with copying and transferring records, if applicable
5. Electronic Transfer Authorization: Specific authorization for electronic transfer of records, including preferred method and security measures
1. Schedule A - Types of Medical Records: Detailed checklist of specific types of medical records that may be released (e.g., laboratory results, imaging reports, consultation notes)
2. Schedule B - Authorized Recipients List: If multiple recipients are authorized, detailed list with specific permissions for each
3. Appendix 1 - Patient Rights Information: Detailed information about patient rights under NZ law regarding medical records and privacy
4. Appendix 2 - Revocation Form: Form that can be used to revoke the authorization if needed
Healthcare
Medical Services
Mental Health
Allied Health
Public Health
Private Healthcare
Insurance
Legal Services
Social Services
Disability Services
Medical Records
Administration
Compliance
Legal
Patient Services
Health Information Management
Quality Assurance
Front Office
Clinical Operations
Privacy and Data Protection
Medical Records Administrator
Healthcare Facility Manager
Privacy Officer
Medical Practice Manager
Clinical Director
General Practitioner
Medical Secretary
Healthcare Administrator
Compliance Officer
Legal Counsel
Patient Services Coordinator
Health Information Manager
Practice Nurse
Medical Receptionist
Quality Assurance Manager
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ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it