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1. Patient Information: Minor's full legal name, date of birth, Hong Kong ID number (if applicable), address, and other identifying information
2. Parent/Legal Guardian Information: Full details of the person(s) authorized to give consent, including relationship to minor, contact information, and proof of authority to consent
3. Emergency Contact Information: Alternative contacts in case parent/guardian cannot be reached
4. Medical History Summary: Brief overview of relevant medical history, allergies, current medications, and known conditions
5. Scope of Consent: Clear description of the medical treatments and procedures being consented to, including routine examinations, emergency care, and specific procedures
6. Duration of Consent: Time period for which the consent remains valid
7. Rights and Responsibilities: Statement of parent/guardian rights, including right to revoke consent and receive information about treatment
8. Privacy Notice: Information about how medical data will be collected, used, and protected under Hong Kong's Personal Data (Privacy) Ordinance
9. Declarations and Signatures: Formal declarations and signature blocks for parent/guardian, witness, and healthcare provider
1. Interpreter Declaration: Required when consent form is explained through an interpreter, including interpreter's details and certification
2. Special Medical Conditions: Additional section for detailing specific medical conditions requiring special attention or modified procedures
3. Religious or Cultural Considerations: Special instructions related to religious or cultural beliefs affecting medical treatment
4. Photography Consent: Optional consent for medical photography or imaging for treatment documentation
5. Research Participation: Optional consent for participation in medical research or teaching activities
1. Schedule A: Detailed Medical Procedures: Comprehensive list and descriptions of specific medical procedures covered by the consent
2. Schedule B: Emergency Protocol: Detailed protocol for emergency situations when immediate parent/guardian consent cannot be obtained
3. Appendix 1: Proof of Guardianship Requirements: List of acceptable documents proving legal guardianship status
4. Appendix 2: Privacy Policy: Detailed privacy policy explaining handling of minor's medical information
Parent
Legal Guardian
Healthcare Provider
Medical Treatment
Emergency Treatment
Routine Care
Consent
Revocation of Consent
Medical Facility
Authorized Representative
Medical Records
Personal Data
Treatment Period
Medical Practitioner
Registered Nurse
Emergency Contact
Medical Emergency
Witness
Capacity
Confidential Information
Medical Procedure
Diagnostic Test
Privacy Notice
Treatment Plan
Healthcare Services
Interpreter
Next of Kin
Medical Consent
Emergency Authorization
Privacy and Confidentiality
Information Disclosure
Duration and Validity
Liability and Indemnification
Revocation Rights
Data Protection
Treatment Authorization
Emergency Contact
Religious or Cultural Preferences
Medical Records Access
Financial Responsibility
Photography and Recording
Witness Requirements
Interpretation Services
Governing Law
Declaration and Attestation
Healthcare
Medical Services
Pediatric Care
Emergency Services
Hospital Administration
Clinical Research
Education (School Health Services)
Sports Medicine
Mental Health Services
Dental Services
Legal
Compliance
Medical Administration
Patient Services
Risk Management
Medical Records
Emergency Services
Pediatrics
Clinical Operations
Quality Assurance
Medical Director
Hospital Administrator
Pediatrician
General Practitioner
Emergency Room Physician
Nurse Manager
Clinical Director
Legal Counsel
Compliance Officer
Risk Management Officer
Patient Services Manager
Medical Records Manager
Privacy Officer
Healthcare Facility Manager
School Nurse
Sports Medicine Physician
Dental Surgeon
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