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1. Parties: Identifies the individual giving consent (the 'Consenter') and the organization/entity requesting the consent (the 'Requesting Party')
2. Background: Brief context explaining why the information release is necessary and the relationship between the parties
3. Definitions: Clear definitions of key terms used in the document, including types of information, parties involved, and technical terms
4. Information to be Released: Detailed specification of the exact information that is authorized for release
5. Purpose of Release: Clear statement of how the released information will be used and why it is being requested
6. Duration of Consent: Specifies how long the consent remains valid, including start and end dates if applicable
7. Rights of the Consenter: Explains the rights to withdraw consent, request access to information, or modify the consent
8. Privacy Notice: Statement about how the information will be protected and handled in accordance with privacy laws
9. Declaration and Signature: Formal declaration of consent and space for signatures, dates, and witness details if required
1. Special Categories of Information: Additional provisions for sensitive information such as health records, financial data, or government identifiers
2. Third Party Recipients: Details of any third parties who may receive the information, used when information will be shared beyond the requesting party
3. International Transfer Provisions: Additional terms for when information may be transferred overseas
4. Emergency Contact Authorization: Used when consent includes permission to contact designated emergency contacts
5. Capacity Declaration: Required when consent is given by a guardian or authorized representative rather than the subject individual
6. Specific Use Limitations: Additional restrictions or conditions on how the information can be used
1. Schedule A - Information Details: Detailed list of specific information types, documents, or records to be released
2. Schedule B - Authorized Recipients: List of specific individuals or organizations authorized to receive the information
3. Schedule C - Privacy Policy Summary: Summary of relevant privacy policies and data protection measures
4. Appendix 1 - Consent Withdrawal Form: Template form for withdrawing consent if desired
5. Appendix 2 - Information Request Form: Standard form for requesting copies of released information
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Client Services
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Records Manager
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Healthcare Administrator
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ұԾ’s Security Promise
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We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
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We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it