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1. Identification of Parties: Details of the individual whose information will be released (data subject) and the organization/person holding the information (data controller)
2. Purpose of Disclosure: Clear statement of why the information is being released and how it will be used, as required by PDPL 2021
3. Information to be Released: Specific description of what information is authorized for release, including categories and time periods of information
4. Recipient Information: Details of who is authorized to receive the information, including organization name, contact details, and relationship to the data subject
5. Duration of Authorization: Specific timeframe for which the authorization is valid
6. Rights and Notifications: Statement of the individual's rights under Saudi law, including right to revoke authorization and receive notification of disclosure
7. Signatures and Date: Space for required signatures, dates, and witness attestation if needed
1. Medical Information Specifics: Additional section when dealing with medical records, including specific health information categories and special authorizations required under Saudi healthcare regulations
2. Electronic Distribution Authorization: Optional section for specifically authorizing electronic transmission of information, including email or digital platforms
3. Third Party Authorization: Section needed when allowing a third party to act on behalf of the data subject, including guardian or power of attorney details
4. International Transfer Consent: Required when information may be transferred outside Saudi Arabia, including specific consents required under PDPL
5. Sensitivity Level Classifications: Optional section for specifying different sensitivity levels of information and corresponding handling requirements
1. Detailed Information Checklist: Itemized list of specific information types authorized for release, with checkboxes or similar selection mechanism
2. Recipient Authorization Details: Additional details about authorized recipients, including specific departments or individuals within an organization
3. Identity Verification Documents: List of acceptable identity verification documents and copies of those provided
Healthcare
Banking and Finance
Education
Insurance
Legal Services
Government Services
Human Resources
Telecommunications
Real Estate
Professional Services
Legal
Compliance
Privacy
Medical Records
Human Resources
Information Security
Risk Management
Administrative Services
Regulatory Affairs
Data Protection
Privacy Officer
Compliance Manager
Legal Counsel
Medical Records Administrator
Human Resources Manager
Data Protection Officer
Information Security Manager
Risk Management Officer
Records Manager
Administrative Coordinator
Healthcare Administrator
Corporate Secretary
Regulatory Affairs Specialist
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