The Emergency Medical Treatment Authorization Form serves as a crucial legal instrument in the Philippine healthcare system, designed to ensure prompt medical attention in emergency situations while maintaining compliance with local healthcare regulations. This document becomes essential when immediate medical decisions are required but the patient is unable to provide direct consent, such as in cases of unconsciousness, severe injury, or when dealing with minors. The form typically includes comprehensive patient information, medical history, treatment authorizations, and emergency contact details, aligning with requirements set forth in the Universal Health Care Act (RA 11223), the Anti-Hospital Deposit Law (RA 10932), and the Data Privacy Act (RA 10173). It is commonly used in various settings including hospitals, schools, workplaces, and care facilities throughout the Philippines.
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1. Patient Information: Essential identifying information about the patient including full name, date of birth, address, and contact details
2. Emergency Contacts: Names and contact information for primary and secondary emergency contacts
3. Medical History Summary: Brief overview of relevant medical conditions, allergies, and current medications
4. Authorization Statement: Clear statement granting healthcare providers authority to administer emergency medical treatment
5. Scope of Authorization: Specific medical procedures and treatments covered by the authorization
6. Financial Responsibility: Statement acknowledging responsibility for medical expenses incurred
7. Duration and Validity: Period for which the authorization remains valid
8. Privacy Notice: Statement regarding the handling of personal and medical information in compliance with the Data Privacy Act
9. Signature Block: Space for signatures of the authorizing party, witnesses, and date of execution
1. Religious or Cultural Preferences: Special instructions regarding treatment preferences based on religious or cultural beliefs
2. Organ Donation Authorization: Optional section for expressing organ donation preferences in case of death
3. Do Not Resuscitate (DNR) Instructions: Special instructions regarding life-saving interventions, if applicable
4. Insurance Information: Details of health insurance coverage and preferred providers
5. Specific Treatment Exclusions: List of any specific treatments or procedures that are not authorized
6. Minor Child Additional Provisions: Additional authorizations and requirements when the patient is a minor
7. Medical Power of Attorney: Optional designation of medical power of attorney for extended decision-making
1. Schedule A - Current Medications List: Detailed list of current medications, dosages, and prescribing physicians
2. Schedule B - Allergy and Medical Conditions: Comprehensive list of known allergies and existing medical conditions
3. Schedule C - Preferred Healthcare Providers: List of preferred hospitals, physicians, and specialists
4. Schedule D - Insurance Information Details: Detailed insurance policy information, including policy numbers and coverage details
5. Appendix 1 - Medical History Form: Detailed medical history questionnaire
6. Appendix 2 - Consent Forms: Additional specific consent forms required by healthcare facilities
Relevant legal definitions
Emergency Medical Treatment
Healthcare Provider
Medical Facility
Authorized Representative
Legal Guardian
Emergency Contact
Medical Emergency
Life-Threatening Condition
Informed Consent
Treatment
Medical Procedure
Personal Information
Medical Information
Sensitive Personal Information
Authorization Period
Minor
Medical Power of Attorney
Do Not Resuscitate (DNR)
Advance Directive
Insurance Provider
Medical History
Pre-existing Condition
Reasonable Care
Vital Signs
Emergency Transportation
Next of Kin
Medical Records
Physician
Witness
Capacity to Consent
Healthcare Provider
Medical Facility
Authorized Representative
Legal Guardian
Emergency Contact
Medical Emergency
Life-Threatening Condition
Informed Consent
Treatment
Medical Procedure
Personal Information
Medical Information
Sensitive Personal Information
Authorization Period
Minor
Medical Power of Attorney
Do Not Resuscitate (DNR)
Advance Directive
Insurance Provider
Medical History
Pre-existing Condition
Reasonable Care
Vital Signs
Emergency Transportation
Next of Kin
Medical Records
Physician
Witness
Capacity to Consent
Clauses
Authorization Grant
Scope of Treatment
Consent
Patient Rights
Medical Information Release
Confidentiality
Financial Responsibility
Liability
Duration
Termination
Privacy Protection
Data Processing
Religious Preferences
Insurance
Emergency Contact
Medical History
Transportation Authorization
Provider Rights
Governing Law
Witness Requirements
Amendments
Revocation
Severability
Force Majeure
Assignment
Scope of Treatment
Consent
Patient Rights
Medical Information Release
Confidentiality
Financial Responsibility
Liability
Duration
Termination
Privacy Protection
Data Processing
Religious Preferences
Insurance
Emergency Contact
Medical History
Transportation Authorization
Provider Rights
Governing Law
Witness Requirements
Amendments
Revocation
Severability
Force Majeure
Assignment
Relevant Industries
Healthcare
Education
Corporate
Insurance
Legal Services
Sports and Recreation
Child Care
Elder Care
Travel and Tourism
Manufacturing
Construction
Event Management
Relevant Teams
Human Resources
Legal
Risk Management
Compliance
Health and Safety
Employee Relations
Medical Services
Emergency Response
Student Affairs
Patient Services
Insurance Claims
Operations
Relevant Roles
Healthcare Administrator
School Principal
Human Resources Manager
Risk Management Officer
Legal Counsel
Compliance Officer
Safety Manager
School Nurse
Occupational Health Officer
Employee Relations Manager
Medical Director
Emergency Services Coordinator
Facility Manager
Camp Director
Sports Coach
Tour Guide
Child Care Center Director
Insurance Claims Manager
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