Authorisation to Release Confidential Information (Australia)

This Authorisation to Release Confidential Information is designed for use in Australia. This legal form is available for immediate download.

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This Authorisation to Release Confidential Information will ensure that only the information you specify is released on your behalf. This authorisation can be given to a physician, attorney, hospital, clinic or school to release confidential information on your behalf. The types of confidential information to be released can vary from financial, educational and legal to your social interactions, both online and in person. This Authorisation is beneficial because it protects your privacy, contains an expiration date and can be revoked at any time.

These important provisions are included in this form:
  • Authorisation Information: Indicates the name and address of the individual authorising release of the information and the individual or entity who will release the confidential information;
  • Types of Confidential Information: Sets forth a checklist covering most types of confidential information;
  • Purpose of Use: Outlines the purposes the confidential information may be used for;
  • Revocation and Expiration Dates: This Authorisation may be revoked at any time or on a specified expiration date.

Protect Yourself and your Rights by using our professionally prepared up-to-date forms.

This lawyer prepared packet includes:
  1. General Information
  2. Instructions and Checklist
  3. Authorisation to Release Confidential Information for use in Australia
Law Compliance: This form complies with the state and territory laws of Australia
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.












Authorisation to Release
Confidential Information
(Australia)








This Packet Includes:
1.  General Information
2.  Instructions and Checklist
3.  Authorisation to Release Confidential Information





General Information
Authorisation to Release Confidential Information

One of the most pressing issues in todays high-tech world is privacy.  Although privacy protection is a concern for both businesses and individuals, it is not uncommon to find yourself in a situation where private information must be disclosed.  For example, a prospective employer or landlord may require personal, financial or even medical information. In these circumstances it is important that you use a document which allows a limited release of information, thereby maintaining as much protection as possible.  Our Authorisation to Release Confidential Information is designed for this situation.  

Our Authorisation to Release Confidential Information form will ensure that only the information you specify is released on your behalf.  This form can be given to your physicians and lawyers, any hospitals and clinics and schools you have attended in order to release personal information on your behalf.  The information to be released varies and can range from financial, educational and legal information to your social interactions both online and in person.  This form is also beneficial because it contains an expiration date and a clause stating the form can be revoked at any time.  

The Privacy Act 1988 lays down 10 Information Privacy Principles to safeguard the privacy and confidentiality of ones personal information. According to this Information Privacy Principles:

1.   Manner and Purpose of Personal Information:

Personal information shall not be collected by a collector for inclusion in a record or in a generally available publication unless:

(a)  the information is collected for a purpose that is a lawful purpose directly related to a function or activity of the collector; and

(b)  the collection of the information is necessary for or directly related to that purpose.

Also, the personal information shall not be collected by a collector by unlawful or unfair means.

2.   Limits on use of personal information 



A recordkeeper who has possession or control of a record that contains personal information that was obtained for a particular purpose shall not use the information for any other purpose unless:


(a)  the individual concerned has consented to use of the information for that other purpose;

(b)  the recordkeeper believes on reasonable grounds that use of the information for that other purpose is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another person;

(c)  use of the information for that other purpose is required or authorised by or under law;

(d)  use of the information for that other purpose is reasonably necessary for enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue; or

(e)  the purpose for which the information is used is directly related to the purpose for which the information was obtained.

Where personal information is used for enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue, the recordkeeper shall include in the record containing that information a note of that use.

3.   Limits on disclosure of personal information

A recordkeeper who has possession or control of a record that contains personal information shall not disclose the information to a person, body or agency (other than the individual concerned) unless:

(a)  the individual concerned is reasonably likely to have been aware, or made aware that information of that kind is usually passed to that person, body or agency;

(b)  the individual concerned has consented to the disclosure;

(c)  the recordkeeper believes on reasonable grounds that the disclosure is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or of another person;

(d)  the disclosure is required or authorised by or under law; or

(e)  the disclosure is reasonably necessary for the enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue.



Where personal information is disclosed for the purposes of enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the purpose of the protection of the public revenue, the recordkeeper shall include in the record containing that information a note of the disclosure.


This Authorisation to Release Confidential Information protects your privacy and can be used once or numerous times.  By purchasing our up-to-date form prepared by a lawyer, you save both your money and peace of mind.  This form can also be used in all states and is available for immediate download.  


Instructions and Checklist


Authorisation to Release Confidential Information

  Read the authorisation carefully.

   Insert all requested information in the spaces provided on the form.

     This form contains sensitive and confidential information.  Please release only information for its intended purposes.  

   This form contains an expiration date provision.  Please review this provision carefully before inserting the expiration date, as it will nullify the release.

     This form contains the basic terms and language that should be included in similar authorisations.  

   Both parties should retain either an original or copy of the signed agreement.

   All legal documents should be kept in a safe location such as a fireproof safe or safe deposit box.  






DISCLAIMER:

FindLegalForms, Inc. (“FLF”) is not a law firm and does not provide legal advice.  The use of these materials is not a substitute for legal advice. Only a lawyer can provide legal advice.  A lawyer should be consulted for all serious legal matters.  No Lawyer-Client relationship is created by use of these materials.  

THESE MATERIALS ARE PROVIDED “AS-IS.  FLF DOES NOT GIVE ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY, SUITABILITY OR COMPLETENESS FOR ANY OF THE MATERIALS FOR YOUR PARTICULAR NEEDS.  THE MATERIALS ARE USED AT YOUR OWN RISK.  IN NO EVENT WILL:  I) FLF, ITS AGENTS, PARTNERS, OR AFFILIATES; OR II) THE PROVIDERS, AUTHORS OR PUBLISHERS OF ITS MATERIALS, BE RESPONSIBLE OR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATE OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER USED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THESE MATERIALS. 



AUTHORISATION TO RELEASE CONFIDENTIAL INFORMATION

I, _________________________ residing at _______________________________________ authorise the following person: __________________________ (Individual, Physician, Hospital, Clinic, Lawyer, School etc.) _________________________________________

To release the following specific confidential information:
(Check all that are applicable)
[  ] Educational Information consisting of ____________________________________
[  ] Developmental Information consisting of _________________________________
[  ] Financial Information consisting of ____________________________________
[  ] Legal Information consisting of ________________________________________
[  ] Medical Information consisting of ______________________________________
[  ] HIV related Information consisting of ___________________________________
[  ] Psychological Reports consisting of _____________________________________
[  ] Social History consisting of ____________________________________________
[  ] Other Information consisting of _______________________________________

To the following individual or organisation ________________________________________ of _________________________________________________________________________
The information released may be used by the individual or the organisation for the following purpose: ___________________________________________________________________
___________________________________________________________________________
I understand that I have a right to revoke this authorisation at any time. I understand that if I revoke this authorisation I must do so in writing.  I understand that the revocation will not apply to information that has already been released in response to this authorisation.

EXPIRATION DATE:  This authorisation will expire on _____________________________
This form was read by me or was read to me and I understand its meaning.  All the applicable blanks were filled in before the form was signed by me.

                  _______________________________________
                  Signature
Number of Pages7
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#34866
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.












Authorisation to Release
Confidential Information
(Australia)








This Packet Includes:
1.  General Information
2.  Instructions and Checklist
3.  Authorisation to Release Confidential Information





General Information
Authorisation to Release Confidential Information

One of the most pressing issues in todays high-tech world is privacy.  Although privacy protection is a concern for both businesses and individuals, it is not uncommon to find yourself in a situation where private information must be disclosed.  For example, a prospective employer or landlord may require personal, financial or even medical information. In these circumstances it is important that you use a document which allows a limited release of information, thereby maintaining as much protection as possible.  Our Authorisation to Release Confidential Information is designed for this situation.  

Our Authorisation to Release Confidential Information form will ensure that only the information you specify is released on your behalf.  This form can be given to your physicians and lawyers, any hospitals and clinics and schools you have attended in order to release personal information on your behalf.  The information to be released varies and can range from financial, educational and legal information to your social interactions both online and in person.  This form is also beneficial because it contains an expiration date and a clause stating the form can be revoked at any time.  

The Privacy Act 1988 lays down 10 Information Privacy Principles to safeguard the privacy and confidentiality of ones personal information. According to this Information Privacy Principles:

1.   Manner and Purpose of Personal Information:

Personal information shall not be collected by a collector for inclusion in a record or in a generally available publication unless:

(a)  the information is collected for a purpose that is a lawful purpose directly related to a function or activity of the collector; and

(b)  the collection of the information is necessary for or directly related to that purpose.

Also, the personal information shall not be collected by a collector by unlawful or unfair means.

2.   Limits on use of personal information 



A recordkeeper who has possession or control of a record that contains personal information that was obtained for a particular purpose shall not use the information for any other purpose unless:


(a)  the individual concerned has consented to use of the information for that other purpose;

(b)  the recordkeeper believes on reasonable grounds that use of the information for that other purpose is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another person;

(c)  use of the information for that other purpose is required or authorised by or under law;

(d)  use of the information for that other purpose is reasonably necessary for enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue; or

(e)  the purpose for which the information is used is directly related to the purpose for which the information was obtained.

Where personal information is used for enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue, the recordkeeper shall include in the record containing that information a note of that use.

3.   Limits on disclosure of personal information

A recordkeeper who has possession or control of a record that contains personal information shall not disclose the information to a person, body or agency (other than the individual concerned) unless:

(a)  the individual concerned is reasonably likely to have been aware, or made aware that information of that kind is usually passed to that person, body or agency;

(b)  the individual concerned has consented to the disclosure;

(c)  the recordkeeper believes on reasonable grounds that the disclosure is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or of another person;

(d)  the disclosure is required or authorised by or under law; or

(e)  the disclosure is reasonably necessary for the enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue.



Where personal information is disclosed for the purposes of enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the purpose of the protection of the public revenue, the recordkeeper shall include in the record containing that information a note of the disclosure.


This Authorisation to Release Confidential Information protects your privacy and can be used once or numerous times.  By purchasing our up-to-date form prepared by a lawyer, you save both your money and peace of mind.  This form can also be used in all states and is available for immediate download.  


Instructions and Checklist


Authorisation to Release Confidential Information

  Read the authorisation carefully.

   Insert all requested information in the spaces provided on the form.

     This form contains sensitive and confidential information.  Please release only information for its intended purposes.  

   This form contains an expiration date provision.  Please review this provision carefully before inserting the expiration date, as it will nullify the release.

     This form contains the basic terms and language that should be included in similar authorisations.  

   Both parties should retain either an original or copy of the signed agreement.

   All legal documents should be kept in a safe location such as a fireproof safe or safe deposit box.  






DISCLAIMER:

FindLegalForms, Inc. (“FLF”) is not a law firm and does not provide legal advice.  The use of these materials is not a substitute for legal advice. Only a lawyer can provide legal advice.  A lawyer should be consulted for all serious legal matters.  No Lawyer-Client relationship is created by use of these materials.  

THESE MATERIALS ARE PROVIDED “AS-IS.  FLF DOES NOT GIVE ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY, SUITABILITY OR COMPLETENESS FOR ANY OF THE MATERIALS FOR YOUR PARTICULAR NEEDS.  THE MATERIALS ARE USED AT YOUR OWN RISK.  IN NO EVENT WILL:  I) FLF, ITS AGENTS, PARTNERS, OR AFFILIATES; OR II) THE PROVIDERS, AUTHORS OR PUBLISHERS OF ITS MATERIALS, BE RESPONSIBLE OR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATE OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER USED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THESE MATERIALS. 



AUTHORISATION TO RELEASE CONFIDENTIAL INFORMATION

I, _________________________ residing at _______________________________________ authorise the following person: __________________________ (Individual, Physician, Hospital, Clinic, Lawyer, School etc.) _________________________________________

To release the following specific confidential information:
(Check all that are applicable)
[  ] Educational Information consisting of ____________________________________
[  ] Developmental Information consisting of _________________________________
[  ] Financial Information consisting of ____________________________________
[  ] Legal Information consisting of ________________________________________
[  ] Medical Information consisting of ______________________________________
[  ] HIV related Information consisting of ___________________________________
[  ] Psychological Reports consisting of _____________________________________
[  ] Social History consisting of ____________________________________________
[  ] Other Information consisting of _______________________________________

To the following individual or organisation ________________________________________ of _________________________________________________________________________
The information released may be used by the individual or the organisation for the following purpose: ___________________________________________________________________
___________________________________________________________________________
I understand that I have a right to revoke this authorisation at any time. I understand that if I revoke this authorisation I must do so in writing.  I understand that the revocation will not apply to information that has already been released in response to this authorisation.

EXPIRATION DATE:  This authorisation will expire on _____________________________
This form was read by me or was read to me and I understand its meaning.  All the applicable blanks were filled in before the form was signed by me.

                  _______________________________________
                  Signature

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