General Consent Form For Medical Treatment Template for Indonesia

1. Interpreter Declaration: Required when consent form is explained through an interpreter for non-Indonesian speaking patients

2. Guardian/Representative Authorization: Required when patient is a minor or lacks capacity to provide consent

3. Religious/Cultural Considerations: Special section for documenting any religious or cultural preferences affecting treatment

4. Teaching Institution Disclosure: Required for teaching hospitals where students/trainees may be involved in care

5. Photography/Recording Consent: Optional authorization for medical photography or recording for documentation/education

6. Clinical Trial/Research Participation: Required if the facility conducts research and may invite patient participation

1. Schedule A - Patient Rights and Responsibilities: Detailed list of patient rights and responsibilities under Indonesian healthcare law

2. Schedule B - Financial Policies: Detailed explanation of billing procedures, insurance claims, and payment policies

3. Schedule C - Privacy Policy: Detailed explanation of how patient information is collected, used, and protected

4. Appendix 1 - Hospital Services Directory: List of available medical services and departments

5. Appendix 2 - Emergency Procedures: Information about emergency protocols and contact procedures