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Patient Information Release Form for Hong Kong

Patient Information Release Form Template for Hong Kong

A comprehensive legal document designed for use in Hong Kong's healthcare system that facilitates the authorized release of patient medical information to designated recipients. This form complies with Hong Kong's Personal Data (Privacy) Ordinance and relevant healthcare regulations, providing a structured framework for healthcare providers to obtain explicit patient consent for sharing medical records. It includes detailed sections for patient identification, specific information to be released, recipient details, purpose of disclosure, and duration of authorization, while incorporating necessary privacy protections and patient rights under Hong Kong law.

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What is a Patient Information Release Form?

The Patient Information Release Form serves as a critical document in Hong Kong's healthcare system, enabling the authorized sharing of medical information while maintaining patient privacy and confidentiality. This form is essential when patients need their medical records shared between healthcare providers, insurance companies, or other authorized parties. It must comply with the Personal Data (Privacy) Ordinance and specific healthcare regulations in Hong Kong, incorporating proper consent mechanisms and clear authorization parameters. The document is designed to protect both healthcare providers and patients by clearly documenting the scope, purpose, and duration of information release, while ensuring all parties understand their rights and obligations under Hong Kong law.

What sections should be included in a Patient Information Release Form?

1. Patient Information: Full identification details of the patient including name, ID number, date of birth, contact information, and medical record number

2. Healthcare Provider Details: Information about the healthcare facility/provider releasing the information, including name, address, and contact details

3. Information to be Released: Specific description of medical information authorized for release, including date ranges and types of records

4. Recipient Authorization: Details of the person or organization authorized to receive the information, including their relationship to the patient

5. Purpose of Disclosure: Clear statement of the reason for releasing the medical information

6. Duration of Authorization: Specification of how long the authorization remains valid

7. Patient Rights Statement: Statement of patient's rights regarding the release of information, including right to revoke authorization

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

What sections are optional to include in a Patient Information Release Form?

1. Special Categories of Information: Additional authorization sections for sensitive information such as mental health records, HIV status, or substance abuse treatment - used when such records may be included

2. Emergency Contact Authorization: Section for authorizing information release to emergency contacts - included when patient wants to pre-authorize emergency disclosures

3. Electronic Release Authorization: Specific consent for electronic transmission of records - included when digital transfer methods may be used

4. Third Party Payment Authorization: Authorization for release of information to insurance companies or other payers - included when payment/reimbursement is involved

What schedules should be included in a Patient Information Release Form?

1. Schedule A - Types of Medical Records: Detailed checklist of different types of medical records that can be released (e.g., consultation notes, test results, imaging reports)

2. Schedule B - Authorized Recipients List: List of pre-authorized recipients and their access levels, if multiple parties are involved

3. Appendix 1 - Privacy Policy Summary: Summary of relevant privacy policies and patient rights under Hong Kong law

4. Appendix 2 - Revocation Form: Form for revoking the authorization if patient wishes to cancel it

Authors

Alex Denne

Head of Growth (Open Source Law) @ Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

Hong Kong

Publisher

Ƶ

Document Type

Consent Form

Cost

Free to use
Relevant legal definitions
























Clauses
















Relevant Industries

Healthcare

Insurance

Medical Research

Pharmaceuticals

Elder Care

Mental Health Services

Public Health

Healthcare Technology

Legal Services

Education (Medical Institutions)

Relevant Teams

Medical Records

Compliance

Legal

Patient Services

Information Security

Risk Management

Quality Assurance

Operations

Clinical Administration

Data Protection

Relevant Roles

Medical Records Officer

Privacy Officer

Healthcare Administrator

Medical Director

Compliance Manager

Data Protection Officer

Clinical Director

Patient Services Manager

Medical Secretary

Legal Counsel

Risk Management Officer

Quality Assurance Manager

Healthcare Operations Manager

Information Security Officer

Industries





Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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