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1. Parties: Identification of the healthcare provider/facility and the patient (including full legal names, addresses, and contact information)
2. Background: Context of the medical treatment or procedure necessitating the waiver
3. Definitions: Clear definitions of medical terms, procedures, and legal terminology used in the document
4. Acknowledgment of Risks: Detailed description of potential risks, complications, and side effects associated with the medical procedure or treatment
5. Voluntary Consent: Declaration that the patient is voluntarily signing the waiver with full mental capacity and without coercion
6. Release of Liability: Specific terms of the waiver releasing the healthcare provider from liability for specified risks and outcomes
7. Emergency Authorization: Authorization for emergency medical treatment if necessary during the procedure
8. Data Privacy Consent: Consent for collection, processing, and storage of medical information in compliance with the Data Privacy Act
9. Governing Law: Statement that the waiver is governed by Philippine law and specification of jurisdiction
10. Execution: Signature blocks for all parties, including witness signatures and date
1. Insurance Declaration: Section addressing insurance coverage and payment responsibilities, used when the procedure may not be covered by insurance
2. Language Certification: Certification that the document has been explained in a language understood by the patient, used when the patient's primary language is not English or Filipino
3. Additional Medical History: Section for detailed medical history when the procedure requires specific health background information
4. Photographic Consent: Authorization for taking and using medical photographs, used particularly in surgical or cosmetic procedures
5. Religious or Cultural Considerations: Special provisions regarding religious or cultural preferences affecting medical care, used when specifically requested by the patient
1. Schedule A - Procedure Details: Detailed description of the medical procedure or treatment being undertaken
2. Schedule B - Risk Disclosure: Comprehensive list of specific risks and potential complications
3. Schedule C - Pre/Post Procedure Instructions: Detailed instructions for before and after the procedure
4. Appendix 1 - Medical History Form: Standard form for recording relevant medical history and current medications
5. Appendix 2 - Emergency Contacts: List of emergency contacts and their relationship to the patient
Healthcare
Medical Services
Hospital Administration
Insurance
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Medical Tourism
Pharmaceutical
Clinical Research
Ambulatory Care
Emergency Services
Legal
Compliance
Risk Management
Patient Relations
Medical Records
Quality Assurance
Clinical Operations
Administrative Services
Insurance Coordination
Patient Safety
Hospital Administrator
Medical Director
Legal Counsel
Compliance Officer
Risk Manager
Chief Medical Officer
Healthcare Facility Manager
Patient Relations Manager
Medical Records Officer
Quality Assurance Manager
Clinical Operations Director
Insurance Coordinator
Medical Practice Manager
Healthcare Legal Administrator
Patient Safety Officer
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