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Authorization To Disclose Protected Health Information for United Arab Emirates

Authorization To Disclose Protected Health Information Template for United Arab Emirates

This document serves as a formal authorization for the release of protected health information under UAE federal healthcare privacy laws, particularly Federal Law No. 2 of 2019 and related regulations. It enables healthcare providers to legally share specified medical information with designated recipients while maintaining compliance with UAE data protection requirements. The document includes comprehensive details about the scope of information to be shared, duration of authorization, and rights of the patient, incorporating both UAE-specific legal requirements and international best practices in healthcare information management.

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Authorization To Disclose Protected Health Information

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What is a Authorization To Disclose Protected Health Information?

The Authorization To Disclose Protected Health Information is a critical document required in the UAE healthcare system whenever protected health information needs to be shared between parties. This document is mandated by UAE Federal Law No. 2 of 2019 and related healthcare regulations, which establish strict requirements for the handling and disclosure of patient information. The authorization form ensures that healthcare providers have documented patient consent before sharing medical records, test results, or other health-related information with specified recipients. It serves as a legal safeguard for both healthcare providers and patients, clearly outlining the scope of information to be shared, the duration of the authorization, and the rights of all parties involved. The document is particularly relevant in cases of medical referrals, insurance claims, legal proceedings, or when patients seek to have their medical information shared with other healthcare providers or authorized entities.

What sections should be included in a Authorization To Disclose Protected Health Information?

1. Patient Information: Complete identification details of the patient including full name, Emirates ID, date of birth, contact information, and medical record number

2. Healthcare Provider Information: Details of the healthcare provider/facility currently holding the medical records, including name, address, and license number

3. Recipient Information: Information about the person or entity authorized to receive the protected health information

4. Information to be Disclosed: Specific description of the health information authorized for disclosure, including type of records, date ranges, and any specific exclusions

5. Purpose of Disclosure: Clear statement of the reason(s) for requesting the disclosure of health information

6. Duration of Authorization: Specific time period for which the authorization is valid, including start and end dates

7. Patient Rights Statement: Statement of patient's rights regarding the authorization, including right to revoke and any limitations

8. Signatures and Date: Space for patient or legal representative signature, date, and witness signature if required

What sections are optional to include in a Authorization To Disclose Protected Health Information?

1. Legal Representative Authorization: Additional section required when someone other than the patient is authorizing the disclosure, including proof of authority

2. Specific Sensitive Information Authorization: Special authorization section for sensitive information such as mental health records, HIV status, or genetic testing results

3. Electronic Disclosure Authorization: Additional provisions when information will be shared electronically, including specific security measures and formats

4. International Transfer Provisions: Required when health information will be transferred outside the UAE, including additional compliance requirements

5. Re-disclosure Notice: Optional but recommended section warning about potential re-disclosure by the recipient

What schedules should be included in a Authorization To Disclose Protected Health Information?

1. Schedule A - Detailed Record List: Itemized list of specific medical records, test results, or documents to be disclosed

2. Schedule B - Fee Schedule: If applicable, breakdown of any fees associated with the record copying and transmission

3. Appendix 1 - Identity Verification Documents: Copies of required identification documents for patient or legal representative

4. Appendix 2 - Supporting Documentation: Any additional documentation required to support the authorization (e.g., power of attorney, court orders)

Authors

Alex Denne

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

Publisher

Genie AI

Cost

Free to use
Relevant legal definitions

























Clauses




















Relevant Industries

Healthcare

Insurance

Legal Services

Pharmaceuticals

Medical Research

Education (Medical)

Government Health Authorities

Healthcare Technology

Occupational Health

Public Health

Relevant Teams

Legal

Compliance

Medical Records

Patient Relations

Risk Management

Quality Assurance

Information Security

Clinical Operations

Healthcare Information Management

Privacy and Data Protection

Relevant Roles

Medical Records Officer

Compliance Manager

Healthcare Administrator

Legal Counsel

Privacy Officer

Medical Director

Insurance Coordinator

Clinical Research Coordinator

Human Resources Manager

Quality Assurance Manager

Patient Relations Manager

Healthcare Information Manager

Data Protection Officer

Medical Secretary

Clinical Documentation Specialist

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,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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