The Medical Release Letter is a crucial document in the Dutch healthcare system, designed to facilitate the authorized sharing of medical information while maintaining patient privacy and complying with legal requirements. This document becomes necessary when medical information needs to be shared between healthcare providers, insurance companies, or other authorized parties. It is governed by Dutch legislation including the Medical Treatment Contracts Act (WGBO), the General Data Protection Regulation (GDPR), and the Dutch Data Protection Act (UAVG). The letter must contain specific elements to be legally valid, including clear patient identification, explicit consent, detailed scope of the information to be released, and the duration of the authorization. This document is particularly important in cases of patient transfers, specialist consultations, insurance claims, or when medical information is needed for legal or administrative purposes.
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1. Patient Information: Full legal name, date of birth, address, patient ID/BSN number, and contact information of the patient
2. Healthcare Provider Information: Name, registration number, facility/practice details, and contact information of the current healthcare provider
3. Recipient Information: Name, role/facility, and contact information of the person or organization authorized to receive the medical information
4. Scope of Release: Specific description of what medical information is being authorized for release, including relevant dates of treatment
5. Purpose of Release: Clear statement of why the medical information is being released and how it will be used
6. Duration of Authorization: Specific timeframe for which the release authorization is valid
7. Patient Rights Statement: Statement of patient's rights regarding revoking authorization and controlling their medical information
8. Signatures and Date: Space for patient (or legal representative) signature, date, and any witness signatures if required
1. Legal Representative Authorization: Required when someone other than the patient is authorizing the release, including details of their legal authority
2. Specific Exclusions: Section listing any specific medical information that should NOT be shared
3. Re-disclosure Notice: Added when information might be re-shared with other parties, explaining limitations and requirements
4. Digital Consent Confirmation: Required for electronic release authorizations, including verification methods
5. Urgent Release Authorization: Added for emergency situations requiring expedited processing
6. Translation Confirmation: Required when the letter is provided in multiple languages, confirming accuracy of translation
1. Detailed Medical Record List: Itemized list of specific medical records being released, including dates and types of documentation
2. Identity Verification Documents: Copies of identity documents used to verify the patient or representative's identity
3. Legal Authority Documentation: Copies of power of attorney or other legal documents proving authority to authorize release
4. Specific Consent Forms: Additional consent forms required for sensitive information (e.g., mental health, HIV status, genetic information)
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Medical Records
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Patient Administration
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Relevant Roles
Medical Doctor
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Medical Records Manager
Insurance Claims Processor
Healthcare Facility Manager
Clinical Research Coordinator
Occupational Health Officer
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School Nurse
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