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Medical Release Form For Family Members Template for England and Wales

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Key Requirements PROMPT example:

Medical Release Form For Family Members

"I need a Medical Release Form For Family Members that allows my sister and mother to access my medical records from London General Hospital, with specific restrictions on mental health information access, valid for one year from January 2025."

Document background
The Medical Release Form For Family Members is essential in situations where family members need access to a patient's medical information for care coordination, decision-making, or support purposes. This document, governed by English and Welsh law, ensures compliance with data protection requirements while facilitating necessary information sharing. It becomes particularly important in cases involving elderly patients, those with chronic conditions, or situations where family members are actively involved in patient care. The form includes detailed specifications about what information can be shared, with whom, and for how long, while maintaining appropriate privacy protections.
Suggested Sections

1. Patient Information: Full details of the patient including name, address, date of birth, NHS number

2. Authorized Family Member Details: Information about the family member requesting access, including relationship to patient

3. Scope of Authorization: Specific medical information being authorized for release

4. Duration of Authorization: Time period for which the authorization is valid

5. Declaration and Signature: Formal authorization statement and signature blocks

Optional Sections

1. Emergency Contact Information: Additional contacts for urgent situations - used when multiple family members may need access

2. Specific Restrictions: Limitations on information access - used when certain medical information should be excluded

3. Mental Capacity Declaration: Statement regarding patient's capacity - used when patient lacks capacity to make decisions

Suggested Schedules

1. Healthcare Providers List: List of relevant healthcare providers authorized to release information

2. Proof of Identity: Copies of identification documents for authorized family member

3. Power of Attorney Documentation: If applicable, copies of relevant legal authority documents

Authors

Alex Denne

Head of Growth (Open Source Law) @ ºÚÁÏÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions


















Clauses















Industries

Data Protection Act 2018 and UK GDPR: Primary legislation governing personal and sensitive medical data processing, including requirements for explicit consent, data subject rights, and security measures for data protection

Access to Health Records Act 1990: Legislation governing access to deceased patients' medical records and defining rights of family members to access medical records

Mental Capacity Act 2005: Framework for decision-making on behalf of those lacking capacity, including provisions for Lasting Powers of Attorney for health and welfare and best interests decision-making

Health and Social Care Act 2012: Establishes general framework for healthcare information sharing and confidentiality requirements in the healthcare sector

Common Law Duty of Confidentiality: Legal principle establishing medical information confidentiality and circumstances where disclosure is permitted

NHS Act 2006: Statutory framework for healthcare provision and information governance requirements within the National Health Service

Human Rights Act 1998: Legislation incorporating Article 8 (right to privacy) and principles for balancing privacy rights with necessary information sharing

Caldicott Principles: Guidelines and principles for handling patient-identifiable information and information sharing in healthcare settings

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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