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Authorisation To Disclose Information
"I need an Authorisation To Disclose Information allowing my medical records to be shared between my current GP and a specialist consultant for a period of 6 months from January 2025, with specific provisions for sharing test results and treatment history."
1. Parties: Details of the authorising party and recipient(s) of information
2. Background: Context and purpose of the authorization
3. Definitions: Key terms used in the authorization
4. Scope of Authorization: Specific information authorized for disclosure
5. Duration: Period for which the authorization is valid
6. Purpose of Disclosure: Permitted uses of the disclosed information
7. Execution: Signature blocks and witnessing requirements
1. Third Party Recipients: Additional parties authorized to receive information - use when information may be shared beyond immediate recipient
2. Revocation Rights: Process for withdrawing authorization - use when authorization period is indefinite or long-term
3. Data Protection Provisions: Specific handling requirements for personal data - use when sensitive personal data is involved
4. Confidentiality Obligations: Requirements for maintaining confidentiality - use when disclosed information is particularly sensitive
1. Schedule of Information: Detailed list of specific information authorized for disclosure
2. Schedule of Recipients: List of authorized recipients and their contact details
3. Privacy Notice: Details of how information will be processed and protected
4. Consent Forms: Additional forms required for specific types of information
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