The Authorization Release Form For Medical Records is a critical document used in New Zealand healthcare settings when there is a need to transfer patient medical information between healthcare providers or to third parties. This form is essential for compliance with the Privacy Act 2020 and the Health Information Privacy Code 2020, ensuring that sensitive health information is handled appropriately and with proper authorization. The document becomes necessary in various situations, such as changing healthcare providers, seeking specialist consultations, insurance claims, legal proceedings, or when patients need their records shared with other authorized parties. It contains specific provisions for identifying the patient, the current record holder, the intended recipient, the scope of information to be released, and the duration of the authorization. The form also includes important privacy statements and patient rights information as required under New Zealand law.
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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
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Mental Health
Allied Health
Public Health
Private Healthcare
Insurance
Legal Services
Social Services
Disability Services
Relevant Teams
Medical Records
Administration
Compliance
Legal
Patient Services
Health Information Management
Quality Assurance
Front Office
Clinical Operations
Privacy and Data Protection
Relevant Roles
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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