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1. Patient Information: Complete identification details of the patient including full name, IC number, date of birth, and contact information
2. Healthcare Provider Information: Details of the hospital, clinic, or medical facility and attending physician(s)
3. Scope of Authorization: Clear description of the medical treatments, procedures, or care being authorized
4. Duration of Authorization: Timeframe for which the authorization remains valid
5. Emergency Contact Information: Details of primary and secondary emergency contacts
6. Consent Declaration: Formal statement of consent and acknowledgment of understanding
7. Signature Block: Space for patient/guardian signature, witness signatures, and dates
1. Alternate Decision Maker Authorization: Required when someone other than the patient is authorized to make medical decisions
2. Specific Treatment Limitations: Used when certain treatments or procedures are explicitly excluded from the authorization
3. Religious or Cultural Considerations: Include when specific religious or cultural preferences need to be documented
4. Insurance Information: Added when insurance coverage details are relevant to the authorized treatment
5. Translator Certification: Required when the document has been explained through a translator
6. Mental Capacity Assessment: Include when there are questions about the patient's capacity to provide informed consent
1. Schedule A: Detailed Medical Procedures: Comprehensive list and description of specific medical procedures being authorized
2. Schedule B: Risks and Benefits: Detailed explanation of potential risks and benefits of authorized treatments
3. Appendix 1: Patient Rights: Statement of patient rights under Malaysian healthcare laws
4. Appendix 2: Advance Directives: Any existing advance directives or living will provisions
5. Appendix 3: Medical History Form: Relevant medical history and current medication list
Authorization Period
Consent
Emergency Contact
Healthcare Facility
Healthcare Provider
Identity Card
Medical Procedure
Medical Treatment
Next of Kin
Patient
Personal Data
Treatment Plan
Witness
Medical Records
Authorized Representative
Capacity
Emergency Treatment
Healthcare Services
Legal Guardian
Medical Practitioner
Mental Capacity
Registered Nurse
Signature Date
Treating Facility
Authorization Scope
Duration
Patient Rights
Confidentiality
Data Protection
Emergency Provisions
Revocation Rights
Healthcare Provider Obligations
Risk Disclosure
Financial Responsibility
Information Access
Communication
Witness Requirements
Governing Law
Capacity Declaration
Religious Considerations
Medical Records
Alternative Decision Making
Liability
Healthcare
Medical Services
Insurance
Legal Services
Education
Sports and Recreation
Manufacturing
Construction
Hospitality
Transportation
Legal
Compliance
Human Resources
Risk Management
Medical Records
Patient Services
Health and Safety
Insurance Administration
Clinical Operations
Quality Assurance
Medical Director
Hospital Administrator
Physician
Nurse Manager
Legal Counsel
Compliance Officer
Risk Manager
Human Resources Manager
Occupational Health Officer
Insurance Coordinator
Medical Records Manager
Patient Services Coordinator
Corporate Health and Safety Manager
School Nurse
Sports Team Doctor
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