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1. Patient Information: Full name, IC/passport number, date of birth, and contact details of the patient
2. Grantor Information: Details of the person giving permission (if different from patient), including relationship to patient and contact information
3. Healthcare Provider Information: Name and details of the hospital, clinic, or medical facility and attending physician(s)
4. Treatment Authorization: Specific medical procedures, treatments, or care being authorized
5. Duration of Authorization: Time period for which the permission is valid
6. Emergency Contact Information: Alternative contacts in case of emergency
7. Declaration and Signature: Formal statement of permission and understanding, with date and signatures of all relevant parties
1. Medical History Summary: Include when relevant medical history could impact treatment decisions
2. Specific Restrictions: Any limitations or specific exclusions to the permission granted
3. Religious/Cultural Considerations: Special instructions based on religious or cultural requirements
4. Interpreter Declaration: Required when the grantor needs language interpretation services
5. Witness Section: Added when additional verification of identity or capacity is needed
6. Travel Authorization: Include when treatment may require travel or transfer to different facilities
1. Medical History Form: Detailed medical history including allergies, current medications, and previous procedures
2. Identity Documents: Copies of IC/passport of patient and permission grantor
3. Legal Authority Documentation: Documents proving authority to grant permission (e.g., guardianship papers, power of attorney)
4. Specific Treatment Details: Detailed description of proposed medical treatments or procedures
5. Insurance Information: Details of medical insurance coverage and policy numbers
Healthcare
Education
Insurance
Corporate
Legal Services
Social Services
Sports and Recreation
Travel and Tourism
Manufacturing (for workplace medical treatment)
Construction
Human Resources
Legal
Compliance
Risk Management
Operations
Administrative Services
Employee Relations
Health and Safety
Student Affairs
Medical Administration
Insurance Claims
Corporate Services
Medical Administrator
Healthcare Facility Manager
School Principal
Human Resources Manager
Legal Compliance Officer
Risk Management Officer
Employee Relations Manager
Insurance Claims Manager
Medical Secretary
School Nurse
Occupational Health Officer
Corporate Legal Counsel
Student Affairs Coordinator
Travel Coordinator
Safety Manager
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