Release Of Information Form Therapy

Release Of Information Form Therapy Template for Austria

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Key Requirements PROMPT example:

"I need a Release Of Information Form Therapy for my private psychology practice in Vienna, compliant with Austrian regulations, that allows sharing of treatment information with referring physicians and includes electronic communication consent."

Document background

The Release Of Information Form Therapy is a crucial document required in Austrian therapeutic practice whenever there is a need to share patient information with third parties. This form is designed to comply with Austrian healthcare regulations, the Austrian Data Protection Act (DSG), and EU GDPR requirements. It is used when therapists need to share patient information with other healthcare providers, insurance companies, or other authorized parties. The document ensures that sensitive therapeutic information is shared only with explicit patient consent and under clearly defined conditions. It includes specific provisions for data protection, detailed consent parameters, and clear documentation of patient rights, making it essential for maintaining legal compliance while facilitating necessary information exchange in therapeutic settings.

Suggested Sections

1. Patient Information: Patient's full identification details including name, date of birth, contact information, and therapy record number

2. Healthcare Provider Information: Details of the therapist/healthcare provider including name, professional registration number, practice details

3. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the information will be released

4. Information to be Released: Detailed specification of exactly which information/records can be shared

5. Authorized Recipients: Identity and contact details of individuals or organizations authorized to receive the information

6. Duration of Authorization: Specific timeframe for which the authorization is valid

7. Patient Rights: Statement of patient's rights including right to revoke authorization and any limitations

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

9. Signatures: Space for patient signature, date, and witness signature if required

Optional Sections

1. Emergency Contact Authorization: Additional section for authorizing information sharing with emergency contacts - used when patient wants to designate emergency contacts

2. Electronic Communication Consent: Specific authorization for sharing information via electronic means - used when electronic transmission of data is anticipated

3. Minor Patient Provisions: Additional provisions when the patient is a minor - used for patients under 18 years

4. Translation Confirmation: Confirmation that the form has been explained in patient's preferred language - used for non-German speaking patients

5. Specific Therapy Information: Details about specific therapy types or approaches - used when multiple therapy types are involved

6. Research Use Authorization: Specific consent for use of information in research - used when data might be used for research purposes

Suggested Schedules

1. Schedule A - Types of Information: Detailed checklist of specific types of information that may be shared (e.g., session notes, assessments, treatment plans)

2. Schedule B - Authorized Recipients List: Detailed list of all authorized recipients with their full contact information and relationship to patient

3. Schedule C - Specific Exclusions: List of specific information or circumstances excluded from the authorization

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

5. Appendix 2 - Privacy Policy: Detailed privacy policy explaining how the information will be handled and protected

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

Mental Health

Psychology

Psychiatry

Social Services

Medical Administration

Healthcare Technology

Data Protection

Legal Services

Relevant Teams

Legal

Compliance

Medical Records

Clinical Administration

Healthcare Operations

Data Protection

Privacy

Patient Services

Quality Assurance

Risk Management

Relevant Roles

Psychotherapist

Clinical Psychologist

Psychiatrist

Mental Health Counselor

Healthcare Administrator

Medical Records Manager

Data Protection Officer

Privacy Officer

Compliance Manager

Healthcare Legal Counsel

Practice Manager

Clinical Director

Medical Secretary

Mental Health Practice Administrator

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