A Medical Release Letter is a critical document in Indonesia's healthcare system that enables the authorized sharing of patient medical information while maintaining compliance with local regulations. This document is required when medical information needs to be shared between healthcare providers, with insurance companies, or with other authorized parties. It must align with Indonesian laws including Law No. 29 of 2004 on Medical Practice and recent data protection regulations. The letter typically includes patient details, scope of information to be released, recipient information, and validity period. It serves as both a legal protection mechanism and a standardized process for information sharing in medical contexts. The document is particularly important in cases involving insurance claims, continuing care scenarios, or when patients seek treatment from multiple healthcare providers.
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1. Healthcare Provider Information: Complete details of the medical facility/provider issuing the release, including registration numbers and contact information
2. Patient Identification: Full patient details including name, date of birth, medical record number, and other relevant identification information
3. Authorization Statement: Clear statement of consent for release of medical information, specifying the scope and purpose of the release
4. Information to be Released: Specific description of medical information being authorized for release, including relevant dates of treatment
5. Recipient Information: Details of the person or entity authorized to receive the medical information
6. Duration of Authorization: Validity period of the release authorization
7. Signature Block: Space for patient signature (or legal representative) with date and witness signature if required
1. Legal Representative Authorization: Required when someone other than the patient is authorizing the release, including proof of authority
2. Specific Restrictions: Any limitations or restrictions on the information to be released
3. Revocation Rights: Statement explaining the right to revoke the authorization and process for doing so
4. Electronic Release Authorization: Additional provisions for electronic release of information, if applicable
5. Translation Statement: Required when the letter is provided in multiple languages
6. Special Conditions: Any specific conditions or requirements for sensitive medical information (e.g., HIV status, mental health records)
1. Patient Identity Documents: Copies of relevant identification documents of the patient
2. Legal Representative Documents: Power of attorney or other documents proving legal authority (if applicable)
3. Specific Medical Records List: Detailed list of specific medical records being authorized for release
4. Witness Verification Form: Additional form for witness verification if required by the healthcare provider
5. Previous Authorization Records: Copies of any previous medical release authorizations if relevant to the current release
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Insurance
Legal Services
Healthcare Technology
Medical Research
Pharmaceutical
Public Health
Occupational Health
Education (Medical Institutions)
Relevant Teams
Legal
Compliance
Medical Records
Patient Services
Administration
Risk Management
Data Protection
Quality Assurance
Customer Relations
Information Management
Relevant Roles
Medical Director
Hospital Administrator
Clinic Manager
Healthcare Compliance Officer
Medical Records Manager
Legal Counsel
Privacy Officer
Patient Relations Manager
Insurance Coordinator
Medical Secretary
Healthcare Administrator
Risk Management Officer
Data Protection Officer
Quality Assurance Manager
Medical Information Officer
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