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The Authorization For Disclosure Of Medical Information is a critical document used in Philippine healthcare settings when there is a need to share patient medical information with third parties. This document is required whenever protected health information needs to be released to entities other than the primary healthcare provider, such as insurance companies, employers, or other healthcare facilities. It ensures compliance with the Data Privacy Act of 2012 and relevant Philippine healthcare regulations, protecting both the healthcare provider and the patient's rights. The authorization typically specifies the scope of information to be released, the purpose of disclosure, the duration of authorization, and includes important patient rights information. This document is particularly important in scenarios involving insurance claims, employment requirements, medical research, or continuing medical care at different facilities.

1. Parties: Identification of the patient (authorizing party), the healthcare provider/facility releasing the information, and the recipient of the medical information

2. Background: Brief context explaining the purpose of the authorization document and its compliance with Philippine law

3. Definitions: Key terms used in the document including 'medical information', 'healthcare provider', 'disclosure', and other relevant terms

4. Scope of Authorization: Specific description of medical information authorized for release, including date ranges and types of records

5. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the medical information will be used

6. Duration of Authorization: Validity period of the authorization and expiration date

7. Rights of the Patient: Statement of patient's rights under Philippine law, including right to revoke authorization

8. Redisclosure Notice: Statement regarding potential redisclosure by the recipient and any applicable limitations

9. Execution: Signature blocks, witnessing requirements, and date of execution