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1. Identification of Parties: Details of the individual whose information will be released (the subject) and the organization/person releasing the information (the holder), including full legal names, contact information, and relevant ID numbers
2. Recipient Information: Complete details of the person or organization authorized to receive the information, including name, contact information, and relationship to the subject
3. Information to be Released: Specific description of the information authorized for release, including type, date range, and format of information
4. Purpose of Release: Clear statement of the purpose for which the information is being released
5. Duration of Authorization: Specific timeframe for which the authorization is valid, including start and end dates
6. Rights and Notifications: Statement of the subject's rights under Qatar law, including right to revoke authorization and any limitations
7. Consent Declaration: Clear statement of consent and understanding of the terms, including acknowledgment of potential re-disclosure risks
8. Signature Block: Space for signatures, dates, and witness information if required
1. Special Categories of Information: Additional authorization sections for sensitive information such as mental health records, HIV status, or genetic information - used when such sensitive information may be included
2. Electronic Disclosure Authorization: Specific permission for electronic transmission of information - included when digital sharing is anticipated
3. Third Party Authorization: Authorization for a third party to act on behalf of the subject - used when someone other than the subject is managing the release
4. Payment Information: Details of any fees associated with the information release - included when applicable charges exist
5. Emergency Contact Information: Contact details for emergencies - included in medical information releases
6. Prohibition on Re-disclosure: Specific restrictions on further sharing of information - used for highly sensitive information
1. Schedule A - Information Details: Detailed listing of specific records, documents, or information to be released
2. Schedule B - Authorized Recipients: List of all authorized recipients if multiple parties are involved
3. Appendix 1 - Terms and Conditions: Detailed terms and conditions governing the information release
4. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how the information will be handled and protected
5. Appendix 3 - Fee Schedule: Schedule of any applicable fees for information release, if relevant
Healthcare
Education
Financial Services
Legal Services
Government Services
Insurance
Real Estate
Human Resources
Banking
Telecommunications
Professional Services
Corporate Services
Legal
Compliance
Human Resources
Information Security
Risk Management
Medical Records
Administrative Services
Operations
Information Management
Privacy
Document Control
Legal Counsel
Compliance Officer
Privacy Officer
Medical Records Manager
Human Resources Director
Information Security Officer
Data Protection Officer
Risk Manager
Healthcare Administrator
Records Manager
Company Secretary
Operations Manager
Administrative Director
Chief Privacy Officer
Information Management Specialist
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