The Medical Records Release Form serves as a crucial document in Pakistan's healthcare system, facilitating the legal and controlled transfer of patient medical information between authorized parties. This document becomes necessary when patient records need to be shared between healthcare providers, released to insurance companies, or provided to other authorized recipients. It ensures compliance with Pakistani healthcare privacy laws and medical practice standards, while protecting both the healthcare provider's liability and patient's rights. The form is designed to accommodate both federal and provincial regulatory requirements, including those set forth by the Pakistan Medical and Dental Council and various provincial healthcare commissions. It includes comprehensive patient identification, specific authorization parameters, and clear documentation of the scope and purpose of the release.
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1. Patient Information: Complete identification details of the patient including name, date of birth, CNIC number, address, and contact information
2. Healthcare Provider Information: Details of the medical facility or healthcare provider currently holding the records
3. Recipient Information: Complete details of the person or entity to whom the medical records will be released
4. Records to be Released: Specific description of medical records being authorized for release, including date ranges and types of records
5. Purpose of Release: Clear statement of the reason for releasing the medical records
6. Duration of Authorization: Specific time period for which this authorization is valid
7. Rights and Notifications: Statement of patient's rights regarding the release of medical records, including right to revoke authorization
8. Authorization Statement: Formal declaration of consent for release of records
9. Signatures: Space for patient or authorized representative signature, date, and witness signature if required
1. Translation Declaration: To be included when the form needs to be provided in multiple languages, certifying the accuracy of translation
2. Legal Representative Authorization: To be included when someone other than the patient is authorizing the release
3. Specific Exclusions: Section specifying any particular records that should NOT be released
4. Fee Schedule: To be included if there are charges associated with copying and releasing records
5. Electronic Records Consent: Additional consent specific to release of records in electronic format
6. Prohibition of Re-disclosure: Statement prohibiting the recipient from further sharing the information without new authorization
1. Schedule A - Types of Medical Records: Detailed checklist of different types of medical records that can be released (e.g., consultation notes, lab reports, imaging reports, etc.)
2. Schedule B - Sensitive Information Authorization: Separate authorization checklist for sensitive information such as psychiatric records, HIV status, or genetic information
3. Appendix 1 - Patient Rights: Detailed explanation of patient rights regarding medical records and their release
4. Appendix 2 - Identity Verification Documents: List of acceptable identity verification documents for patient/representative authentication
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