The Authorization For Disclosure Of Health Information Form is a critical document used in Australian healthcare settings when there is a need to share patient health information with third parties. This form ensures compliance with the Privacy Act 1988 (Cth), the Australian Privacy Principles, and state-specific health records legislation. It is required whenever patient health information needs to be released to other healthcare providers, insurance companies, legal representatives, or other authorized recipients. The form includes specific details about what information can be shared, with whom, for what purpose, and for how long. It serves as a legal record of the patient's consent and helps healthcare providers maintain appropriate privacy standards while facilitating necessary information sharing.
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1. Patient Information: Essential identifying information including full name, date of birth, address, contact details, and Medicare number
2. Healthcare Provider Details: Information about the healthcare provider/organization releasing the information, including name, address, and contact details
3. Recipient Information: Details of the person or organization authorized to receive the health information
4. Information to be Disclosed: Specific description of what health information is authorized for release, including date ranges and types of records
5. Purpose of Disclosure: Clear statement of why the information is being released and how it will be used
6. Duration of Authorization: Specific timeframe for which the authorization is valid
7. Patient Rights Statement: Clear explanation of the patient's rights regarding the authorization, including right to revoke
8. Authorization Statement: Formal declaration of consent for information release
9. Signature Block: Space for patient or authorized representative signature, date, and witness details
1. Authorized Representative Details: Only included when someone other than the patient is authorizing the release, including their relationship to the patient and basis for authority
2. Specific Exclusions: Section for specifying any particular information that should NOT be disclosed
3. Fee Disclosure: Include when there are costs associated with the information release
4. Electronic Transfer Consent: Additional consent section specifically for electronic transfer of records, if applicable
5. Interpreter Declaration: Required when an interpreter has been used to explain the form to the patient
1. Schedule A - Types of Health Information: Detailed checklist of different types of health information that can be disclosed (e.g., medical records, test results, mental health records, etc.)
2. Schedule B - Approved Recipients List: If multiple recipients are authorized, detailed list with full contact information for each
3. Appendix 1 - Privacy Notice: Detailed privacy notice explaining how the information will be handled and protected
4. Appendix 2 - Revocation Form: Form that can be used by the patient to revoke the authorization
Relevant legal definitions
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Healthcare
Medical Services
Allied Health
Insurance
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Government Healthcare
Research Institutions
Aged Care
Mental Health Services
Disability Services
Relevant Teams
Legal
Compliance
Medical Records
Patient Services
Administration
Privacy & Data Protection
Quality Assurance
Risk Management
Clinical Operations
Information Management
Relevant Roles
Medical Records Officer
Privacy Officer
Healthcare Administrator
Compliance Manager
Medical Practice Manager
Health Information Manager
Legal Counsel
Healthcare Provider
Clinical Director
Patient Services Coordinator
Quality Assurance Manager
Risk Management Officer
Data Protection Officer
Medical Secretary
Practice Nurse
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