Medical Info Release Form

Medical Info Release Form Template for Austria

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Key Requirements PROMPT example:

"I need a Medical Info Release Form that allows my private clinic in Vienna to share patient records with multiple hospital departments across Austria, ensuring GDPR compliance and including provisions for both electronic and physical records transfer."

Document background

The Medical Info Release Form is a critical document used in Austrian healthcare settings to facilitate the legal and compliant transfer of patient medical information. This document is essential when patients need to authorize the sharing of their medical records with other healthcare providers, insurance companies, or other authorized parties. It is designed to comply with both Austrian healthcare laws and EU GDPR requirements, particularly regarding the handling of sensitive personal health data. The form includes comprehensive patient identification, specific authorization parameters, clear purpose declaration, and explicit consent mechanisms. It's particularly important in situations involving ongoing medical treatment, insurance claims, legal proceedings, or when transferring care between providers. The document ensures that all parties involved in the information exchange are clearly identified and that the scope and duration of the authorization are precisely defined.

Suggested Sections

1. Patient Information: Full legal name, date of birth, address, contact information, and any relevant identification numbers of the patient

2. Healthcare Provider Information: Details of the medical facility or healthcare provider currently holding the medical records

3. Recipient Information: Details of the person or entity authorized to receive the medical information

4. Scope of Authorization: Specific description of what medical information is authorized for release, including date ranges and types of records

5. Purpose of Disclosure: Clear statement of the reason for releasing the medical information

6. Duration of Authorization: Specification of how long the authorization remains valid

7. Rights and Notices: Statement of patient rights including right to revoke authorization and receive copies of released information

8. Data Protection Statement: GDPR-compliant privacy notice explaining how the information will be processed and protected

9. Signatures: Space for patient signature, date, and any required witness or notary signatures

Optional Sections

1. Special Categories Authorization: Additional authorization for sensitive information such as mental health records, HIV status, or genetic information - include when such specific records are part of the release

2. Minor Patient Provisions: Additional section for cases involving minors, including parent/guardian authorization details

3. Electronic Transmission Authorization: Specific authorization for electronic transmission of records - include when digital transfer is anticipated

4. Translation Declaration: For non-German speaking patients, confirmation that the form has been explained in their preferred language

5. Emergency Contact: Optional section for emergency contact information - particularly relevant for ongoing authorizations

Suggested Schedules

1. Schedule A - Detailed Record List: Itemized list of specific medical records to be released, including dates and record types

2. Schedule B - Authorized Recipients List: If multiple recipients are authorized, detailed list with contact information and purpose for each

3. Appendix 1 - Patient Rights Summary: Detailed explanation of patient rights regarding medical information under Austrian law and GDPR

4. Appendix 2 - Privacy Notice: Detailed GDPR-compliant privacy notice explaining data processing practices and protection measures

Authors

Alex Denne

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

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Medical Services

Insurance

Legal Services

Pharmaceuticals

Clinical Research

Healthcare Technology

Medical Education

Public Health

Occupational Health

Relevant Teams

Legal

Compliance

Medical Records

Patient Services

Operations

Privacy and Data Protection

Administrative Services

Risk Management

Clinical Operations

Quality Assurance

Relevant Roles

Medical Records Administrator

Privacy Officer

Healthcare Administrator

Compliance Manager

Medical Practice Manager

Legal Counsel

Data Protection Officer

Healthcare Provider

Insurance Claims Processor

Medical Office Coordinator

Clinical Research Coordinator

Healthcare Operations Manager

Patient Services Representative

Medical Records Technician

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