The Basic Medical Release Form is a crucial document in Australian healthcare settings that enables the authorized sharing of patient medical information. This form is essential when medical records need to be transferred between healthcare providers, shared with insurance companies, or released to other authorized parties. It ensures compliance with the Privacy Act 1988, Australian Privacy Principles, and state-specific health records legislation. The document is designed to protect patient privacy while facilitating necessary information sharing, requiring explicit consent for the release of specified medical information. It includes clear identification of all parties involved, specific details about the information to be released, the purpose of the release, and the duration of the authorization. This form is particularly important in maintaining proper documentation of consent and ensuring legal compliance in medical information management.
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1. Patient Information: Patient's full name, date of birth, address, contact details, and any relevant identification numbers (Medicare, healthcare identifier)
2. Healthcare Provider Details: Information about the healthcare provider or facility releasing the medical information, including name, address, and contact details
3. Recipient Information: Details of the person or organization authorized to receive the medical information, including name, address, and relationship to patient
4. Information to be Released: Specific description of medical information authorized for release, including date ranges and types of records
5. Purpose of Release: Statement of the intended use or reason for releasing the medical information
6. Authorization Statement: Clear statement of authorization, including acknowledgment of understanding and voluntary consent
7. Duration of Authorization: Specification of how long the authorization remains valid
8. Rights and Revocation: Statement of patient's rights, including right to revoke authorization and any limitations
9. Signatures: Space for patient or authorized representative signature, date, and witness signature if required
1. Specific Consent for Sensitive Information: Additional authorization section for sensitive information such as mental health records, HIV status, or genetic information - used when such information may be included in the records
2. Representative Authority: Section for cases where someone other than the patient is authorizing the release, including legal authority documentation - used for minors or individuals unable to consent
3. Electronic Records Authorization: Specific authorization for release of electronic health records - used when digital records are involved
4. Interstate/International Transfer: Additional provisions for when information is being transferred across state or international borders - used for inter-jurisdictional releases
5. Fee Schedule: Information about any applicable fees for records release - used when the provider charges for record copying
1. Schedule A - Types of Medical Information: Detailed checklist of specific types of medical information that may be released (e.g., test results, imaging reports, consultation notes)
2. Schedule B - Authorized Recipients List: List of all authorized recipients when multiple parties are involved in receiving the information
3. Appendix 1 - Privacy Notice: Detailed privacy notice explaining how the released information will be handled and protected
4. Appendix 2 - Revocation Form: Template form for revoking the medical release authorization
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Allied Health
Insurance
Legal Services
Education
Employment
Social Services
Aged Care
Disability Services
Relevant Teams
Medical Records
Administration
Compliance
Legal
Risk Management
Human Resources
Patient Services
Information Management
Privacy & Data Protection
Clinical Operations
Relevant Roles
Medical Practitioner
Practice Manager
Healthcare Administrator
Medical Records Officer
Privacy Officer
Compliance Manager
Legal Counsel
Insurance Claims Processor
Human Resources Manager
Occupational Health Officer
School Nurse
Medical Secretary
Clinical Director
Risk Management Officer
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