The Minor Medical Consent Form is an essential document in Indonesian healthcare settings, required whenever medical treatment is to be provided to individuals under 18 years of age. This form becomes particularly crucial in situations where immediate parental presence may not be possible but medical care might be necessary. The document must comply with Law No. 36 of 2009 on Health and Law No. 35 of 2014 on Child Protection, among other relevant regulations. It typically includes comprehensive information about the minor, their medical history, authorized treatments, and emergency contacts. Healthcare providers rely on this document to ensure they have proper authorization to treat minors while maintaining legal compliance and protecting all parties' interests. The form can be used for ongoing medical care, specific procedures, or emergency situations, providing healthcare providers with clear guidelines on the scope of authorized treatment.

1. Parent/Guardian Information: Full legal details of the parent(s) or legal guardian(s) providing consent, including their relationship to the minor

2. Minor's Information: Complete details of the minor including full name, date of birth, gender, and any relevant identification numbers

3. Authority Declaration: Statement confirming the legal authority of the parent/guardian to provide medical consent for the minor

4. Scope of Consent: Clear outline of the medical treatments and procedures being authorized, including routine check-ups, emergency care, and specific procedures

5. Duration of Consent: Specification of the time period for which the consent remains valid

6. Healthcare Provider Authorization: Details of the healthcare providers or facilities authorized to provide treatment

7. Information Sharing Consent: Authorization for sharing medical information with specified healthcare providers and facilities

8. Emergency Contact Information: List of emergency contacts and their contact details in order of priority

9. Signature Block: Space for dated signatures of parent(s)/guardian(s) and witness