The Consent To Disclose Medical Information document is a crucial legal instrument in the Philippine healthcare system, designed to protect patient privacy while facilitating necessary information sharing. It is required whenever medical information needs to be shared with parties other than the direct healthcare provider, ensuring compliance with the Data Privacy Act of 2012 and relevant healthcare regulations. This document is commonly used in scenarios such as insurance claims, employment requirements, transfer of medical records between healthcare providers, or research purposes. It must specify the scope of information to be disclosed, the purpose of disclosure, and the duration of consent, while clearly outlining the patient's rights under Philippine law. The document serves as a safeguard against unauthorized disclosure while providing a clear audit trail for legitimate information sharing.
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1. Parties: Identifies the patient (data subject), the healthcare provider/facility holding the records, and the intended recipient(s) of the medical information
2. Background: Brief context explaining why the medical information needs to be disclosed
3. Definitions: Defines key terms used in the document including 'medical information', 'disclosure', 'authorized recipients', and other relevant terms
4. Scope of Information: Clearly specifies which medical information is authorized for disclosure, including date ranges and types of records
5. Purpose of Disclosure: States the specific purpose(s) for which the medical information will be used
6. Duration of Consent: Specifies how long the consent remains valid
7. Rights of the Patient: Outlines the patient's rights under the Data Privacy Act, including right to withdraw consent
8. Authorization Statement: Formal statement of consent with signature block for the patient or authorized representative
1. Special Categories of Information: Additional consent requirements for sensitive information like HIV status, mental health records, or genetic information
2. Minor/Incapacitated Patient Provisions: Special provisions when the patient is a minor or legally incapacitated, including authority of guardians
3. Electronic Transmission Authorization: Specific consent for electronic transmission of records, including associated risks
4. Re-disclosure Provisions: Terms regarding whether recipients can further disclose the information to other parties
5. Emergency Contact Authorization: Authorization for disclosure to emergency contacts in specific circumstances
1. Schedule A - Detailed Medical Record List: Itemized list of specific medical records authorized for disclosure
2. Schedule B - Authorized Recipients: Complete list of authorized recipients and their contact information
3. Schedule C - Identity Verification Requirements: Required documentation and procedures for verifying the identity of recipients
4. Appendix 1 - Patient Rights Information Sheet: Detailed explanation of patient rights under Philippine law regarding medical information
Relevant legal definitions
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Healthcare
Insurance
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Education
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Pharmaceutical
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Government Healthcare
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Relevant Teams
Legal
Compliance
Medical Records
Human Resources
Privacy and Data Protection
Patient Services
Quality Assurance
Risk Management
Administrative Services
Clinical Operations
Relevant Roles
Medical Records Officer
Privacy Officer
Compliance Manager
Healthcare Administrator
Medical Director
Human Resources Manager
Insurance Claims Processor
Legal Counsel
Clinical Research Coordinator
Occupational Health Officer
Data Protection Officer
Healthcare Facility Manager
Patient Relations Manager
Medical Secretary
Healthcare Quality Assurance Manager
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