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1. Identification of Parties: Details of the data subject (person whose information will be released), the organization/person releasing the information, and the recipient(s) of the information
2. Information to be Released: Specific description of the personal data/information to be disclosed, including type, scope, and time period of information
3. Purpose of Release: Clear statement of the purpose(s) for which the information will be used by the recipient
4. Duration of Authorization: Specification of how long the authorization to release information remains valid
5. Rights and Acknowledgments: Statement of the data subject's rights under Hong Kong law, including right to withdraw consent
6. Authorization Statement: Formal declaration of consent to release the specified information
7. Signature Block: Space for signatures, dates, and witness information if required
1. Medical Information Specifics: Additional section when form relates to medical records, including specific health information categories and relevant healthcare provider details
2. Third Party Authorization: Section to be included when someone other than the data subject is authorized to consent to the release (e.g., parent, guardian, power of attorney)
3. Cross-border Transfer Details: Required when information will be transferred outside of Hong Kong, specifying destination countries and additional safeguards
4. Fee Schedule: Optional section detailing any fees associated with the information release process
5. Electronic Processing Consent: Additional consent section when information will be processed or transmitted electronically
1. Schedule A - Detailed Information List: Comprehensive list of specific documents/information to be released, especially useful for complex requests involving multiple types of information
2. Schedule B - Authorized Recipients: List of all authorized recipients when multiple parties are involved, including their contact details and roles
3. Appendix 1 - Privacy Policy Summary: Summary of relevant privacy policies and data protection measures applicable to the information release
4. Appendix 2 - Data Subject Rights: Detailed explanation of data subject rights under Hong Kong's Personal Data (Privacy) Ordinance
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