Medical Release Form Template - United Arab Emirates

Medical Release Form for United Arab Emirates

Medical Release Form Template for United Arab Emirates

This Medical Release Form Template is designed for use in the United Arab Emirates healthcare system, complying with Federal Law No. 2 of 2019 (Health Data Law) and other relevant UAE healthcare regulations. The document facilitates the authorized release of medical information between healthcare providers, patients, and other relevant parties while ensuring proper patient privacy protection and data handling procedures. It includes comprehensive sections covering patient identification, scope of information release, duration of authorization, and necessary legal disclaimers, all structured to meet UAE healthcare compliance requirements and available in both Arabic and English as mandated by UAE law.

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What is a Medical Release Form?

The Medical Release Form Template has been developed to meet the specific requirements of the United Arab Emirates healthcare sector, addressing the need for standardized medical information sharing while maintaining compliance with UAE federal and emirate-level healthcare regulations. This document is essential when healthcare providers need to share patient medical information with other authorized parties, whether for continued care, insurance purposes, or other legitimate medical needs. The template incorporates all necessary elements required by UAE law, including patient rights under Federal Law No. 2 of 2019 and the Medical Liability Law, while providing flexibility for various medical scenarios. It's designed to protect both healthcare providers and patients by clearly documenting consent and establishing the scope and duration of medical information release authorization.

What sections should be included in a Medical Release Form?

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

2. Healthcare Provider Information: Details of the medical facility/provider requesting the release, including license numbers and contact information

3. Scope of Release: Specific description of what medical information is authorized for release, including time period covered

4. Purpose of Disclosure: Clear statement of why the medical information is being released and who will receive it

5. Duration of Authorization: Specific timeframe for which the release authorization is valid

6. Rights and Notifications: Statement of patient's rights regarding the release, including right to revoke and any limitations

7. Confidentiality Statement: Declaration regarding how the released information will be protected and handled

8. Signature Block: Space for patient or authorized representative signature, date, and witness signatures if required

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

1. Special Authorization: Additional authorization section for sensitive information like mental health records, HIV status, or genetic testing - used when such specific information needs to be released

2. Emergency Contact: Section for emergency contact details - included when the form might be used in emergency situations

3. Legal Representative Authorization: Additional section when the patient is a minor or legally incapable of providing consent

4. Electronic Distribution Authorization: Optional section for authorizing electronic transmission of records - used when digital transfer is anticipated

5. Payment Information: Section for any applicable fees for record release - included when charges apply for record copying/transfer

6. International Transfer Consent: Additional section for cases where medical information might be transferred outside the UAE

What schedules should be included in a Medical Release Form?

1. Schedule A - Types of Medical Information: Detailed checklist of specific types of medical information authorized for release

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

3. Appendix 1 - Patient Rights: Detailed explanation of patient rights regarding medical information in accordance with UAE law

4. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how medical information will be handled and protected

5. Appendix 3 - Fee Schedule: If applicable, detailed breakdown of any fees associated with the release of medical records

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

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What is a Medical Release Form?

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

What schedules should be included in a Medical Release Form?

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Alex Denne

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