Share Medical Information Form

Share Medical Information Form for Switzerland

Share Medical Information Form Template for Switzerland

A Share Medical Information Form governed by Swiss law is a legally binding document that authorizes the sharing of a patient's medical information between specified healthcare providers and authorized recipients. This document complies with the Federal Act on Data Protection (FADP/DSG) and the Federal Act on Electronic Patient Records (EPRA/EPDG), ensuring proper handling of sensitive medical data while protecting patient privacy rights. The form includes detailed specifications about what information can be shared, with whom, for what purpose, and for how long, while incorporating necessary safeguards and patient rights under Swiss healthcare regulations.

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What is a Share Medical Information Form?

The Share Medical Information Form is a critical document used in Swiss healthcare settings when there is a need to share patient medical information between different healthcare providers or authorized parties. This form is essential for maintaining compliance with Swiss data protection laws, particularly the FADP/DSG and EPRA/EPDG, while facilitating necessary medical information exchange. It becomes relevant when patients require coordinated care across multiple providers, during referrals, for insurance purposes, or in research contexts. The document ensures that sensitive medical data is shared securely and legally, with explicit patient consent, while preserving patient rights and privacy protections under Swiss law. Healthcare providers must use this form to document patient authorization before sharing any protected health information with third parties.

What sections should be included in a Share Medical Information Form?

1. Patient Information: Full legal name, date of birth, address, contact details, and health insurance information of the patient

2. Healthcare Provider Details: Information about the primary healthcare provider/facility authorized to share the information

3. Authorized Recipients: List of healthcare providers, institutions, or individuals authorized to receive the medical information

4. Scope of Authorization: Specific medical information authorized for sharing, including time period covered

5. Purpose of Disclosure: Clearly stated purpose(s) for which the medical information may be shared

6. Duration of Authorization: Validity period of the authorization and expiration date

7. Patient Rights: Statement of patient's rights including right to revoke authorization and receive copies

8. Signatures: Spaces for patient signature (or legal representative) and date, with witness signature if required

What sections are optional to include in a Share Medical Information Form?

1. Legal Representative Authorization: Required when the form is signed by someone other than the patient (e.g., parent, guardian, power of attorney)

2. Specific Exclusions: Section listing any specific medical information that should NOT be shared

3. Emergency Contact: Optional section for emergency contact information

4. Electronic Records Consent: Additional consent specifically for electronic sharing of records, required if electronic sharing is anticipated

5. Language Confirmation: Required for non-native speakers, confirming the form has been explained in a language they understand

What schedules should be included in a Share Medical Information Form?

1. List of Authorized Information: Detailed checklist of specific medical information types authorized for sharing (e.g., test results, medications, diagnoses)

2. Recipient Details: Detailed information about each authorized recipient, including contact details and professional credentials

3. Privacy Notice: Summary of relevant privacy laws and patient rights under Swiss law

4. Revocation Form: Template form for revoking the authorization if needed

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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