The Military Medical Records Release Form is a crucial document used within the Canadian Armed Forces for managing the authorized disclosure of military personnel medical information. This form becomes necessary when medical records need to be shared with authorized parties outside the immediate military healthcare system, such as civilian healthcare providers, veterans' services, or other authorized recipients. It ensures compliance with Canadian federal privacy laws, military regulations, and healthcare information protection requirements. The document includes comprehensive details about the service member, scope of authorization, recipient information, and privacy provisions, while incorporating specific military protocols and security considerations. This form is particularly important for maintaining the confidentiality and proper handling of sensitive medical information while facilitating necessary information sharing for healthcare continuity and administrative purposes.
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1. Service Member Information: Full identification details of the military service member including name, service number, rank, and current unit
2. Authorization Statement: Clear statement of consent for the release of medical records, including the legal basis for the release
3. Scope of Release: Specific details about which medical records are to be released, including date ranges and types of records
4. Recipient Information: Details of the person or organization authorized to receive the medical records
5. Duration of Authorization: Timeframe for which the authorization remains valid
6. Privacy Notice: Statement regarding how the information will be protected and used
7. Revocation Rights: Information about the right to revoke the authorization and the process for doing so
8. Signatures and Attestation: Space for required signatures, dates, and witness attestation
1. Third Party Authorization: Additional section when records are being released to someone other than the service member or immediate healthcare provider
2. Special Categories of Records: Section for specifically authorizing release of sensitive records such as mental health, substance abuse, or HIV-related information
3. Emergency Contact Information: Optional section for including emergency contact details when relevant to the purpose of release
4. International Release Provisions: Additional terms when records are being released to entities outside of Canada
5. Digital Records Format: Specifications for electronic record transfer when records are requested in digital format
1. Schedule A - Types of Medical Records: Detailed checklist of specific types of medical records that may be released
2. Schedule B - Authorized Recipients List: Complete list of all authorized recipients and their contact information when multiple parties are involved
3. Schedule C - Privacy Protocols: Detailed information about privacy and security measures for handling the released records
4. Appendix 1 - Glossary of Terms: Definitions of medical and military terms used in the records
5. Appendix 2 - Instructions for Record Request: Step-by-step guide for how to submit and process the records request
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