The Release Of Information Form Mental Health is a critical document used in New Zealand's healthcare system to manage the secure and compliant sharing of sensitive mental health information. This document becomes necessary when mental health records need to be shared between healthcare providers, with insurance companies, or with other authorized parties. It ensures compliance with New Zealand's Privacy Act 2020, Health Information Privacy Code 2020, and Mental Health (Compulsory Assessment and Treatment) Act 1992. The form serves as both a legal record of consent and a detailed specification of what information can be shared, with whom, and for what purpose. It includes essential patient protections and reflects the heightened privacy considerations required for mental health information in the New Zealand healthcare context.
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1. Patient Information: Patient's full name, date of birth, contact details, and any relevant identification numbers
2. Healthcare Provider Details: Information about the mental health provider or facility currently holding the records
3. Recipient Information: Details of the person or organization to whom the information will be released
4. Information to be Released: Specific description of what mental health information is authorized for release
5. Purpose of Release: Clear statement of why the information is being released
6. Duration of Authorization: Timeframe for which the authorization is valid
7. Rights and Notifications: Statement of patient's rights regarding the release, including right to revoke
8. Consent Declaration: Formal consent statement and signature block for patient or authorized representative
1. Interpreter Declaration: Section for interpreter details and signature when patient requires language assistance
2. Guardian Authorization: Additional section when release is authorized by a legal guardian or power of attorney
3. Specific Exclusions: Section to explicitly state any information that should NOT be released
4. Emergency Contact: Details of emergency contact person, particularly relevant for ongoing treatment situations
5. Re-disclosure Notice: Additional warnings about potential re-disclosure of information by recipients
6. Electronic Records Consent: Specific consent for release of information in electronic format
1. Schedule A - Detailed Record List: Itemized list of specific records or document types to be released
2. Schedule B - Glossary: Definitions of medical and technical terms used in the form
3. Schedule C - Privacy Statement: Detailed privacy notice explaining how information will be handled
4. Appendix 1 - Patient Rights: Comprehensive explanation of patient rights regarding their health information
5. Appendix 2 - Revocation Form: Form that can be used to revoke the authorization
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Mental Health Services
Social Services
Legal Services
Public Health
Healthcare Technology
Medical Insurance
Education (for student health services)
Government Health Agencies
Relevant Teams
Legal
Compliance
Medical Records
Patient Services
Mental Health Services
Clinical Operations
Quality Assurance
Privacy and Data Protection
Healthcare Administration
Information Management
Relevant Roles
Mental Health Professional
Psychiatrist
Psychologist
Clinical Social Worker
Healthcare Administrator
Medical Records Manager
Privacy Officer
Compliance Manager
Mental Health Nurse
General Practitioner
Healthcare Facility Director
Legal Counsel
Patient Services Coordinator
Health Information Manager
Quality Assurance Specialist
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