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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
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
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
Healthcare
Manufacturing
Construction
Education
Transportation
Retail
Information Technology
Financial Services
Energy
Chemical Industry
Food Processing
Pharmaceuticals
Logistics
Mining
Agriculture
Human Resources
Legal
Compliance
Occupational Health
Privacy Office
Health & Safety
Employee Relations
Risk Management
Benefits Administration
Medical Services
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
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