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The design of proper models for authorization and access control for electronic patient record (EPR) is essential to a wide scale use of EPR in large health organizations. In this paper, we propose a contextual role-based access control authorization model aiming to increase the patient privacy and the confidentiality of patient data, whereas being flexible enough to consider specific cases. This model regulates user's access to EPR based on organizational roles. It supports a role-tree hierarchy with authorization inheritance; positive and negative authorizations; static and dynamic separation of duties based on weak and strong role conflicts. Contextual authorizations use environmental information available at access time, like user/patient relationship, in order to decide whether a user is allowed to access an EPR resource. This enables the specification of a more flexible and precise authorization policy, where permission is granted or denied according to the right and the need of the user to carry out a particular job function.