The Standard Release of Information Form serves as a crucial document in India's information sharing landscape, particularly in healthcare and professional services contexts. This document is essential when there is a need to legally and securely share confidential information between authorized parties while maintaining compliance with Indian privacy laws and regulations. It is commonly used in healthcare settings, insurance processing, legal proceedings, and various professional contexts where protected information needs to be shared with third parties. The form includes specific provisions required by Indian law, including explicit consent mechanisms, clear purpose specification, and defined validity periods. It helps organizations maintain compliance with the Information Technology Act 2000, data protection rules, and sector-specific regulations while facilitating necessary information exchange.
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1. Identification Information: Details of the person whose information will be released (name, date of birth, address, contact information, identification numbers)
2. Information Provider Details: Details of the organization/entity that currently holds the information (healthcare provider, institution, or organization)
3. Recipient Information: Details of the person/organization to whom the information will be released
4. Information to be Released: Specific description of what 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. Rights and Notices: Statement of the individual's rights regarding the information release, including right to revoke and any limitations
8. Signatures and Date: Space for signatures of the authorizing individual (or legal representative) and date of signing
1. Specific Consent for Sensitive Information: Additional consent section for sensitive information like HIV status, mental health records, or genetic information - used when such specific information might be included
2. Legal Representative Authorization: Section for cases where someone other than the subject is authorizing the release - used when the subject is a minor or legally incapacitated
3. Electronic Transmission Authorization: Specific consent for electronic transmission of information - used when digital transfer methods may be employed
4. Re-disclosure Notice: Additional notice about potential re-disclosure by the recipient - used when information might be further shared by the recipient
5. Payment Information: Section for any fees associated with the information release - used when there are charges for copying or transmitting records
1. Schedule A - Types of Information Checklist: Detailed checklist of specific types of information that may be released (medical records, test results, prescriptions, etc.)
2. Schedule B - Approved Delivery Methods: List of approved methods for transmitting the information (mail, secure email, fax, etc.)
3. Appendix 1 - Privacy Notice: Detailed privacy notice explaining how the information will be protected and used
4. Appendix 2 - Revocation Form: Form that can be used to revoke the authorization
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Insurance
Legal Services
Education
Human Resources
Government Services
Financial Services
Social Services
Medical Research
Pharmaceutical
Relevant Teams
Legal
Compliance
Medical Records
Patient Services
Information Security
Privacy
Operations
Human Resources
Risk Management
Clinical Administration
Data Protection
Quality Assurance
Relevant Roles
Medical Records Officer
Compliance Manager
Privacy Officer
Healthcare Administrator
Legal Counsel
Human Resources Manager
Insurance Claims Processor
Medical Administrator
Data Protection Officer
Clinical Research Coordinator
Practice Manager
Information Security Officer
Patient Services Coordinator
Records Management Specialist
Healthcare Privacy Specialist
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