Medical Consent Form Template for Indonesia

1. Interpreter Declaration: Required when the patient's primary language is not Indonesian or English, including interpreter's certification of accurate translation

2. Legal Representative Authorization: Required when the patient is a minor, unconscious, or legally incompetent, including details of the representative's authority

3. Photography/Recording Consent: Required when the procedure may involve medical photography or recording for documentation or educational purposes

4. Blood Transfusion Specific Consent: Required for procedures that may require blood transfusion, including specific risks and religious considerations

5. Research Participation: Required when the procedure is part of a research study or clinical trial

6. Teaching Institution Disclosure: Required in teaching hospitals where medical students/residents may be involved in care

7. Cost Information: Optional section detailing expected costs and financial responsibilities

1. Procedure Information Sheet: Detailed medical information about the specific procedure, including preparation instructions and post-procedure care

2. Anatomical Diagrams: Visual representations of the procedure area and planned intervention

3. Risk Statistics: Statistical information about procedure outcomes and risk frequencies

4. Hospital Policy Attachments: Relevant hospital policies regarding patient rights and responsibilities

5. Emergency Contact Form: Form for recording emergency contact information and next of kin details