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Medical Release Form For Work for the Netherlands

Medical Release Form For Work Template for Netherlands

A Dutch Medical Release Form for Work is a legally binding document that complies with both the General Data Protection Regulation (GDPR) and specific Dutch healthcare privacy laws. This document facilitates the authorized disclosure of an employee's relevant medical information between healthcare providers, employers, and occupational health services while ensuring proper data protection measures. The form incorporates specific requirements under Dutch law, including provisions from the Working Conditions Act (Arbeidsomstandighedenwet) and the Medical Treatment Contracts Act (WGBO), establishing clear boundaries for medical information sharing in the employment context.

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Medical Release Form For Work

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What is a Medical Release Form For Work?

The Medical Release Form For Work is a crucial document in Dutch employment relationships where medical information needs to be shared between healthcare providers, employers, and occupational health services. This form becomes necessary when an employee's medical condition affects their work capacity, requires workplace accommodations, or during return-to-work processes following medical leave. The document ensures compliance with Dutch privacy laws, including GDPR implementation (AVG), the Working Conditions Act, and healthcare privacy regulations. It specifically outlines what medical information can be shared, with whom, and under what circumstances, while protecting the employee's privacy rights and ensuring proper data handling procedures are followed.

What sections should be included in a Medical Release Form For Work?

1. Identification of Parties: Details of the employee, employer, and relevant medical professional(s) or occupational health service

2. Purpose of Release: Clear statement of why medical information is being requested and how it will be used in the employment context

3. Scope of Medical Information: Specific description of what medical information is being authorized for release, ensuring compliance with GDPR principles of data minimization

4. Duration of Authorization: Time period for which the authorization is valid, including expiration date if applicable

5. Rights and Revocation: Employee's rights regarding their medical information, including the right to revoke authorization

6. Data Protection Measures: Description of how the medical information will be protected, stored, and eventually destroyed

7. Signatures and Date: Space for signatures of all parties and dating of the document

What sections are optional to include in a Medical Release Form For Work?

1. Special Categories of Data: Additional provisions for sensitive medical information requiring extra protection under GDPR, used when specific conditions or treatments need to be disclosed

2. Third Party Disclosure: Authorization for sharing information with specific third parties, included when medical information needs to be shared beyond the immediate employer

3. International Transfer Provisions: Required when medical information may be transferred outside the EU/EEA

4. Emergency Contact Authorization: Optional section for authorizing release of information to emergency contacts, used in cases of serious health situations

5. Workplace Accommodations: Section detailing any specific workplace adjustments needed based on medical condition, included when relevant to job performance

What schedules should be included in a Medical Release Form For Work?

1. Schedule A: Specific Medical Information Checklist: Detailed checklist of specific medical information authorized for release

2. Schedule B: Authorized Recipients List: List of specific individuals or roles authorized to receive the medical information

3. Schedule C: Privacy Notice: Detailed privacy notice explaining how medical information will be processed, stored, and protected

4. Appendix 1: Revocation Form: Template form for revoking medical information release authorization

5. Appendix 2: Glossary of Medical Terms: Definitions of medical terms used in the release form for clarity

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

Netherlands

Document Type

Authorization Form

Cost

Free to use
Relevant legal definitions




























Clauses




















Relevant Industries

Healthcare

Manufacturing

Construction

Education

Transportation

Retail

Information Technology

Financial Services

Energy

Chemical Industry

Food Processing

Pharmaceuticals

Logistics

Mining

Agriculture

Relevant Teams

Human Resources

Legal

Compliance

Occupational Health

Privacy Office

Health & Safety

Employee Relations

Risk Management

Benefits Administration

Medical Services

Relevant Roles

HR Manager

Occupational Health Physician

Privacy Officer

Data Protection Officer

HR Business Partner

Compliance Manager

Health and Safety Manager

Risk Manager

Employee Relations Manager

Benefits Administrator

HR Director

Workplace Health Coordinator

Legal Counsel

Company Doctor

HR Operations Manager

Industries






Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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