The Consent Form For Release of Information is a crucial document required under Indonesian data protection law, particularly following the implementation of Law No. 27 of 2022 on Personal Data Protection (PDP Law). This document is essential when organizations need to collect, process, or share personal information about individuals, requiring explicit consent from the data subject. It should be used whenever personal data is being collected for specific purposes, whether in healthcare, financial services, employment, or other contexts. The form serves as evidence of compliance with Indonesian data protection requirements and helps organizations demonstrate their commitment to protecting individual privacy rights. It includes detailed information about the types of data being collected, the purposes of collection, who will have access to the data, how it will be protected, and the rights of the data subject under Indonesian law.
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1. Title and Date: Clear identification of the document as a Consent Form for Release of Information with the date of execution
2. Parties: Identification of the data subject (person giving consent) and the organization/entity requesting the information, including full names, addresses, and contact details
3. Purpose of Consent: Clear statement of the specific purpose(s) for which the information will be collected, used, and disclosed
4. Information to be Released: Detailed description of the specific personal data/information that will be collected and shared
5. Duration of Consent: Specification of how long the consent will remain valid and when it will expire
6. Rights of the Data Subject: Statement of the data subject's rights under Indonesian law, including right to withdraw consent and request data deletion
7. Data Protection Measures: Overview of how the information will be protected and secured
8. Declaration and Signature: Formal declaration of consent and space for signatures of all parties
1. Third Party Recipients: List of third parties who may receive the information (include when information will be shared with other organizations)
2. International Transfer: Details about cross-border data transfers (include when data will be transferred outside Indonesia)
3. Specific Processing Activities: Detailed description of specific data processing activities (include for complex data processing scenarios)
4. Commercial Purpose Declaration: Statement about commercial use of data (include when data will be used for commercial purposes)
5. Sensitive Data Handling: Special provisions for handling sensitive personal data (include when collecting sensitive personal information)
1. Schedule A - Detailed Information List: Comprehensive list of all specific information/data points to be collected and shared
2. Schedule B - Third Party Recipients: Detailed list of all third parties who may receive the information, including their contact details and purposes
3. Appendix 1 - Data Subject Rights Guide: Detailed explanation of the data subject's rights and procedures for exercising them
4. Appendix 2 - Privacy Policy Reference: Reference to or summary of the organization's privacy policy and data protection practices
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Research and Development
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Relevant Teams
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Compliance
Human Resources
Information Security
Data Protection
Risk Management
Operations
Customer Service
Information Technology
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Data Protection Officer
Privacy Manager
Compliance Officer
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Healthcare Administrator
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