The Medical Release Form For Minor is a vital legal document used in Indonesia when parents or legal guardians need to authorize medical treatment for their minor children in their absence. This document becomes particularly important in various scenarios such as school attendance, sports activities, travel, or any situation where immediate parental presence cannot be guaranteed. The form, governed by Indonesian healthcare and child protection laws, includes comprehensive information about the minor's medical history, emergency contacts, and specific treatment authorizations. It provides healthcare providers with the necessary legal authority to administer medical care while protecting both the medical practitioners and the child's interests. The document must comply with Indonesian legal requirements, including Law No. 36 of 2009 on Health and relevant medical consent regulations.
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1. Identification of Parties: Details of the minor (full name, date of birth, ID number), parent(s)/legal guardian(s), and their relationship to the minor
2. Authority Grant: Clear statement of medical authority being granted, including scope of medical decisions and treatments authorized
3. Duration of Authorization: Specification of the time period for which the authorization is valid
4. Emergency Contact Information: List of primary and secondary emergency contacts with complete contact details
5. Medical Information: Essential medical information including allergies, current medications, and pre-existing conditions
6. Consent Declaration: Formal declaration of consent for medical treatment and procedures
7. Release of Liability: Statement releasing healthcare providers from liability when acting in good faith within the scope of the authorization
8. Signature Block: Space for dated signatures of parent(s)/guardian(s), witnesses, and notarization if required
1. Religious or Cultural Preferences: Special instructions regarding religious or cultural considerations for medical treatment
2. Insurance Information: Details of medical insurance coverage and payment responsibilities
3. Special Instructions: Any specific instructions or restrictions regarding certain types of treatment or procedures
4. Travel Authorization: Additional authorization for medical treatment during travel, particularly relevant for school trips or temporary caregivers
5. Privacy Notice: Additional privacy provisions regarding the handling of the minor's medical information
1. Medical History Form: Detailed medical history including past surgeries, hospitalizations, and chronic conditions
2. Vaccination Record: Current vaccination status and schedule
3. List of Authorized Caregivers: Comprehensive list of individuals authorized to accompany minor for medical treatment
4. Insurance Documentation: Copies of relevant insurance cards and coverage information
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Education
Child Care Services
Medical Insurance
Legal Services
Youth Sports and Recreation
Emergency Services
Travel and Tourism
Relevant Teams
Legal
Healthcare Administration
Risk Management
Emergency Services
School Administration
Medical Records
Compliance
Patient Services
Child Safety
Relevant Roles
Healthcare Administrator
School Principal
School Nurse
Medical Director
Legal Counsel
Risk Management Officer
Emergency Room Director
Pediatrician
Family Physician
School Administrator
Camp Director
Sports Coach
Travel Program Coordinator
Child Care Center Director
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