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1. Patient Information: Full legal name, identification number (IC/passport), date of birth, address, and contact information of the patient
2. Emergency Contacts: Names, relationships, and contact information for primary and secondary emergency contacts
3. Authorization Grant: Clear statement of authorization for emergency medical treatment, including scope of permitted interventions
4. Medical Personnel Authorization: Specific authorization for healthcare providers to perform necessary emergency procedures
5. Financial Responsibility: Statement regarding responsibility for medical expenses incurred during emergency treatment
6. Release of Information: Authorization to release medical information to specified emergency contacts and relevant healthcare providers
7. Duration and Validity: Period for which the authorization remains valid and conditions for renewal
8. Declarations and Signatures: Formal declarations by the authorizing party and space for signatures, including witness signatures
1. Religious Preferences: Specific religious requirements or restrictions regarding medical treatment, particularly relevant for Muslim patients
2. Specific Medical Conditions: Details of existing medical conditions, allergies, or specific medical needs that emergency personnel should be aware of
3. Organ Donation Authorization: Optional section for organ donation preferences in case of fatal emergencies
4. Language Preferences: Preferred language for communication and need for interpreters, particularly relevant in Malaysia's multilingual context
5. Insurance Information: Details of medical insurance coverage and preferred healthcare facilities
6. Alternative Treatment Preferences: Specific preferences for alternative or traditional medicine treatments where applicable
1. Schedule A - Medical History Form: Detailed medical history including past surgeries, chronic conditions, and current medications
2. Schedule B - Emergency Contact Details: Extended contact information including work, home, and alternative contact numbers for all listed emergency contacts
3. Schedule C - Healthcare Provider Network: List of preferred healthcare providers and facilities with their contact information
4. Appendix 1 - Medication List: Current medication list including dosages, frequencies, and known drug allergies
5. Appendix 2 - Consent for Specific Procedures: Detailed consent forms for specific high-risk emergency procedures
Authorization Period
Authorized Representative
Emergency Contact
Emergency Medical Treatment
Healthcare Facility
Healthcare Provider
Identity Card
Legal Guardian
Medical Emergency
Medical Personnel
Medical Procedure
Medical Record
Next of Kin
Patient
Personal Data
Reasonable Medical Care
Treatment Cost
Urgent Care
Witness
Consent
Medical Decision-Making
Financial Responsibility
Liability Release
Confidentiality
Data Protection
Religious Preferences
Duration and Termination
Emergency Contact
Information Disclosure
Insurance
Legal Capacity
Medical Records
Power of Attorney
Witness Requirements
Governing Law
Severability
Amendment
Revocation
Healthcare
Insurance
Education
Sports and Recreation
Tourism and Hospitality
Manufacturing
Construction
Mining and Resources
Transportation
Events and Entertainment
Legal
Human Resources
Compliance
Risk Management
Operations
Health and Safety
Emergency Response
Administrative Services
Medical Services
Customer Relations
Healthcare Administrator
Legal Counsel
Human Resources Manager
School Principal
Medical Director
Compliance Officer
Risk Manager
Employee Relations Manager
Occupational Health and Safety Manager
Emergency Services Coordinator
Sports Director
Camp Director
Tour Operator
Event Manager
Facility Manager
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