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Medical Authority Form for United Arab Emirates

Medical Authority Form Template for United Arab Emirates

This document is a comprehensive Medical Authority Form designed for use in the United Arab Emirates healthcare system, complying with Federal Law No. 4 of 2016 and related healthcare regulations. It enables a patient to authorize a designated representative to make medical decisions and access medical information on their behalf. The form includes detailed provisions for patient identification, scope of authority, duration of authorization, and specific medical preferences, while incorporating UAE-specific legal requirements for healthcare documentation and patient rights protection.

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What is a Medical Authority Form?

The Medical Authority Form serves as a crucial legal document within the UAE healthcare system, enabling patients to delegate medical decision-making authority to a trusted representative. This document becomes essential when patients need someone to make healthcare decisions on their behalf, whether due to temporary incapacity, planned medical procedures, or ongoing healthcare management. The form must comply with UAE Federal Law No. 4 of 2016 (Medical Liability Law) and related healthcare regulations, including specific requirements from various emirates' health authorities. It contains comprehensive sections covering patient identification, representative authorization, scope of authority, and specific medical preferences, while ensuring adherence to local legal requirements for witnessing and authentication.

What sections should be included in a Medical Authority Form?

1. Patient Information: Full legal name, Emirates ID number, date of birth, contact details, and medical record number of the patient

2. Authorized Representative Details: Full legal name, Emirates ID number, contact details, and relationship to patient of the person being granted medical authority

3. Scope of Authority: Detailed description of medical decisions and actions the representative is authorized to make on behalf's of the patient

4. Duration of Authority: Specific timeframe for which the authorization is valid, including start date and expiration date if applicable

5. Emergency Contact Information: Alternative contacts in case the authorized representative cannot be reached

6. Declarations and Acknowledgments: Statement of patient's understanding and voluntary execution of the form

7. Revocation Rights: Information about the patient's right to revoke the authority and the process for doing so

8. Signatures: Space for patient, authorized representative, and witness signatures with dates

What sections are optional to include in a Medical Authority Form?

1. Specific Medical Conditions: Section detailing particular medical conditions requiring special consideration, used when the patient has specific ongoing health issues

2. Religious/Cultural Preferences: Special instructions regarding religious or cultural considerations in medical treatment, included when patient has specific religious or cultural requirements

3. Organ Donation Authorization: Specific instructions regarding organ donation, included when patient wishes to address this matter

4. Mental Health Treatment Decisions: Special provisions for mental health treatment decisions, included when relevant to patient's condition

5. End-of-Life Care Preferences: Specific instructions regarding end-of-life care, included for elderly or terminally ill patients

6. Translation Certificate: Certificate of translation if the form is provided in multiple languages, required when patient's primary language is not Arabic or English

What schedules should be included in a Medical Authority Form?

1. Schedule A - Medical History Summary: Brief summary of relevant medical history and current conditions

2. Schedule B - Medication List: Current medications, dosages, and known drug allergies

3. Schedule C - Healthcare Providers: List of current healthcare providers and facilities involved in patient's care

4. Appendix 1 - Witness Requirements: Detailed requirements for witness signatures and qualifications as per UAE law

5. Appendix 2 - Instructions for Healthcare Providers: Guidelines for healthcare providers on honoring and implementing the medical authority

6. Appendix 3 - Supporting Documents: List of required supporting documents such as Emirates ID copies, relationship proof documents

Authors

Alex Denne

Head of Growth (Open Source Law) @ Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Publisher

Ƶ

Document Type

Consent Form

Cost

Free to use
Relevant legal definitions






























Clauses

























Relevant Industries

Healthcare

Medical Services

Hospital Administration

Emergency Medical Services

Clinical Services

Medical Insurance

Legal Services

Healthcare Compliance

Medical Records Management

Patient Care Services

Relevant Teams

Legal Affairs

Medical Records

Patient Relations

Clinical Services

Quality Assurance

Risk Management

Compliance

Emergency Services

Admissions

Document Management

Relevant Roles

Medical Director

Hospital Administrator

Legal Compliance Officer

Healthcare Facility Manager

Medical Records Manager

Patient Relations Manager

Clinical Services Director

Emergency Department Coordinator

Admissions Officer

Legal Affairs Manager

Healthcare Quality Manager

Patient Safety Officer

Risk Management Director

Medical Insurance Coordinator

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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