Medical Waiver Template for Belgium

1. Language Declaration: Required when the waiver is provided in multiple languages, specifying which version is legally binding

2. Specific Contraindications: Used when the procedure has specific contraindications that need to be explicitly acknowledged

3. Insurance Details: Include when specific insurance arrangements need to be acknowledged or disclosed

4. Alternative Treatments: Required when alternative treatment options need to be documented as having been discussed and declined

5. Research Participation: Include when the procedure involves any research or experimental aspects

6. Photographic Consent: Used when photographic or video documentation of the procedure may be required

7. Third Party Authorization: Include when decisions may need to be made by someone other than the patient

1. Schedule 1 - Detailed Procedure Description: Technical medical description of the procedure(s)

2. Schedule 2 - Risk Disclosure Form: Detailed list of all potential risks and complications with statistical information where available

3. Schedule 3 - Patient Medical History: Patient's relevant medical history and current conditions form

4. Appendix A - Patient Information Leaflet: Detailed information about the procedure in lay terms

5. Appendix B - Post-Procedure Care Instructions: Details of required after-care and follow-up procedures

6. Appendix C - Emergency Contact Form: Emergency contact information and authorized decision-makers