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1. Date and Location: Current date and place where the letter is being written
2. Subject Line: Clear indication that this is a Medical Authorization Letter for Pregnancy-Related Care
3. Pregnant Woman's Details: Full name, ID number, contact information, and current residential address of the pregnant woman
4. Authorized Party Details: Full name(s), ID number(s), and contact information of the person(s) being authorized to make decisions
5. Scope of Authorization: Specific medical decisions and actions being authorized, including routine care, emergency procedures, and specific treatments
6. Duration of Authorization: Time period for which the authorization is valid, typically covering the pregnancy period and immediate postpartum care
7. Medical Information: Relevant medical details including expected due date, treating physician, and hospital/facility details
8. Declaration of Sound Mind: Statement confirming the pregnant woman is of sound mind and making this authorization voluntarily
9. Signature Block: Space for signatures of the pregnant woman, authorized parties, and witnesses
1. Special Medical Conditions: Section detailing any specific medical conditions, allergies, or complications that healthcare providers should be aware of
2. Religious or Cultural Preferences: Specific religious or cultural considerations that should be respected during medical care
3. Alternative Authorized Parties: Secondary or tertiary authorized persons in case primary authorized person is unavailable
4. Revocation Clause: Specific terms under which the authorization can be revoked by the pregnant woman
5. Language Preference: Preferred language for medical communication, particularly relevant in multi-lingual South Africa
1. Medical History Summary: Brief summary of relevant medical history, previous pregnancies, and current pregnancy details
2. Emergency Contact List: Prioritized list of emergency contacts with their full contact details and relationship to the pregnant woman
3. Copy of Identity Documents: Copies of ID documents of both the pregnant woman and authorized parties
4. Healthcare Provider Details: List of current healthcare providers, including obstetrician, GP, and chosen hospital or birthing facility
Healthcare
Medical Services
Legal Services
Insurance
Social Services
Emergency Services
Legal
Medical Administration
Patient Care
Emergency Services
Risk Management
Records Management
Insurance Administration
Clinical Operations
Social Services
Obstetrician
Gynecologist
Medical Doctor
Nurse Practitioner
Midwife
Hospital Administrator
Healthcare Facility Manager
Legal Counsel
Medical Records Officer
Patient Care Coordinator
Emergency Room Doctor
Social Worker
Healthcare Risk Manager
Medical Insurance Coordinator
Patient Rights Advocate
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