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1. Parties: Identifies healthcare provider and patient
2. Background: Context of treatment/procedure and relevant medical information
3. Definitions: Key terms used in the waiver including medical terminology
4. Acknowledgment of Risks: Patient confirmation of understanding all potential risks and complications
5. Scope of Waiver: Extent and limitations of liability release, including non-waivable rights
6. Patient Declarations: Confirmations of capacity, understanding, and voluntary agreement
7. Execution: Signature blocks for patient, healthcare provider, and witness requirements
1. Emergency Contact Details: Contact information for next of kin or emergency contact, recommended for high-risk procedures
2. Insurance Details: Patient's insurance information and coverage details for private healthcare services
3. Alternative Treatment Options: Documentation of other available treatment choices discussed with patient
4. Post-Procedure Care: Recovery instructions and patient responsibilities following treatment
1. Schedule 1: Detailed Risk Disclosure: Comprehensive list of potential risks, complications, and side effects
2. Schedule 2: Pre-Procedure Instructions: Specific preparation requirements and guidelines before treatment
3. Appendix A: Medical History Form: Detailed patient medical history and current health status
4. Appendix B: Consent Forms: Additional specific consent requirements and supplementary authorizations
Treatment
Medical Procedure
Healthcare Provider
Patient
Liability
Waiver
Informed Consent
Medical Facility
Healthcare Services
Medical Records
Confidential Information
Emergency Care
Force Majeure
Governing Law
Jurisdiction
Material Risks
Medical Emergency
Next of Kin
Professional Standards
Side Effects
Complications
Urgent Care
Working Day
Legal Guardian
Witness
Effective Date
Termination Date
Capacity
Consent
Assumption of Risk
Informed Consent
Release of Liability
Medical Emergency Authorization
Confidentiality
Medical Records Access
Termination Rights
Force Majeure
Governing Law
Severability
Integration
Amendment
Patient Representations
Healthcare Provider Obligations
Insurance
Data Protection
Privacy
Payment Terms
Dispute Resolution
Notice Requirements
Capacity Declaration
Witness Requirements
Indemnification
Survival
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