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1. Personal Information: Details of the principal (person giving authorization) including full legal name, date of birth, address, and insurance information
2. Agent Designation: Identification and contact information of the designated healthcare agent(s) who will make medical decisions
3. Scope of Authority: Detailed description of the medical decisions and actions the agent is authorized to make or take
4. GDPR Consent: Explicit consent for processing personal health data in accordance with EU-GDPR requirements
5. Duration of Authority: Specification of when the authorization begins and ends, including any triggering conditions
6. Agent's Powers: Specific powers granted to the agent regarding medical treatments, procedures, and access to medical records
7. Certification and Signatures: Formal signatures section including principal, agent(s), and witnesses as required by German law
1. Alternate Agents: Designation of backup agents if the primary agent is unavailable or unable to serve
2. Specific Medical Directives: Detailed instructions for specific medical conditions or treatments the principal wants to address
3. Religious/Cultural Preferences: Statement of religious or cultural preferences that should guide medical decisions
4. Organ Donation: Specific wishes regarding organ and tissue donation
5. Digital Health Records Access: Specific authorization for access to electronic health records and digital health platforms
6. International Treatment Authorization: Additional provisions for medical treatment outside Germany
7. Revocation Process: Detailed process for how the principal can revoke the authorization
1. Schedule A: Prohibited Treatments: List of specific medical treatments or procedures that the agent is not authorized to approve
2. Schedule B: Medical History Summary: Brief medical history including current conditions, medications, and allergies
3. Schedule C: Healthcare Providers: List of current healthcare providers and medical facilities
4. Appendix 1: Witness Attestation Form: Required witness statements and signatures confirming the principal's capacity
5. Appendix 2: Physician's Statement: Optional physician's statement confirming the principal's mental capacity at the time of signing
6. Appendix 3: GDPR Privacy Notice: Detailed privacy notice explaining how medical information will be handled under GDPR
Healthcare Agent
Alternate Agent
Medical Care
Healthcare Provider
Medical Treatment
Medical Records
Personal Data
Sensitive Health Data
Capacity
Medical Institution
Emergency Care
Informed Consent
Life-Sustaining Treatment
Palliative Care
Power of Attorney
Revocation
Treatment Decision
Attending Physician
Medical Facility
Data Controller
Data Processor
Healthcare Services
Incapacity
Effective Date
Termination Date
Witness
Notarial Authentication
Medical Intervention
Digital Health Records
Insurance Provider
Medical Emergency
Healthcare Directive
Supporting Documentation
Powers of Attorney
Medical Decision Making
Data Protection
Privacy
Consent
Duration and Termination
Revocation Rights
Emergency Powers
Record Access
Liability
Succession
Certification
Witness Requirements
Medical Records Access
GDPR Compliance
Healthcare Provider Instructions
Insurance Authorization
International Treatment
Religious Preferences
Organ Donation
Life Support
Alternative Medicine
Digital Health Access
Confidentiality
Dispute Resolution
Severability
Governing Law
Healthcare
Medical Services
Elder Care
Legal Services
Insurance
Healthcare Administration
Medical Records Management
Patient Care Services
Emergency Medical Services
Legal Affairs
Medical Records
Patient Services
Compliance
Risk Management
Emergency Services
Administrative Services
Privacy and Data Protection
Patient Relations
Insurance Coordination
Medical Director
Hospital Administrator
Legal Counsel
Healthcare Compliance Officer
Medical Records Manager
Patient Services Coordinator
Emergency Room Physician
Family Practice Doctor
Healthcare Social Worker
Risk Management Officer
Privacy Officer
Medical Office Manager
Admissions Coordinator
Healthcare Attorney
Insurance Coordinator
Patient Advocate
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