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Patients share personal health data by granting access rights to users or medical institutions. The major purpose of the existing access control techniques is to identify users who are permitted to access medical data. They hardly ever recognize internal assailants from legitimate entities. Medical data will involve multilayer access within the authorized organizations. Considering the cost of permissions management and the problem of insider malicious node attacks, users hope to implement authorization constraints within the authorized institutions. It can prevent their data from being maliciously disclosed by end\u2010users from different authorized healthcare domains. For the purpose to achieve the fine\u2010grained permissions propagation control of medical data in sharing institutions, a trust\u2010based authorization access control mechanism is suggested in this study. Trust thresholds are assigned to different privileges based on their sensitivity and used to generate zero\u2010knowledge proof to be broadcasted among blockchain nodes. This method evaluates the trust of each user through the dynamic trust calculation model. And meanwhile, smart contract is employed to verify whether the user\u2019s trust can activate some permissions and ensure the privacy of the user\u2019s trust in the process of authorization verification. In addition, the authorization transaction between users and institutions is recorded on the blockchain for patient traceability and accountability. 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