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1. Patient Information: Essential identifying details including full legal name, date of birth, CNIC number, address, and contact information
2. Emergency Contacts: Names and contact information for primary and secondary emergency contacts with their relationship to the patient
3. Medical Authorization: Clear statement authorizing medical treatment, including scope of authorization and who is authorized to provide treatment
4. Medical History Summary: Critical medical information including allergies, current medications, and significant medical conditions
5. Consent Declaration: Legal declaration of consent, including acknowledgment of risks and understanding of the authorization given
6. Duration and Validity: Specification of how long the authorization remains valid and circumstances under which it expires
7. Signatures: Space for patient/guardian signature, date, and witness signatures as required by law
1. Religious Preferences: Specific religious considerations affecting medical treatment, used when patient indicates religious requirements
2. Guardian Information: Details of legal guardian, required when form is for a minor or person lacking capacity
3. Specific Treatment Exclusions: List of any treatments specifically not authorized, included when patient has specific treatment preferences
4. Language Assistance: Preferred language and interpreter requirements, included for non-English/Urdu speaking patients
5. Insurance Information: Health insurance details and billing preferences, optional for private healthcare facilities
1. Detailed Medical History Form: Comprehensive medical history including past surgeries, conditions, and family history
2. Medication List: Complete list of current medications, dosages, and prescribing physicians
3. Treatment Facility List: List of approved healthcare facilities where authorization is valid
4. Authorization Card Template: Wallet-sized emergency authorization card summarizing key information and contacts
Healthcare Provider
Medical Facility
Authorized Representative
Legal Guardian
Next of Kin
Capacity to Consent
Medical Emergency
Life-Saving Procedures
Treatment
Medical Personnel
Authorized Medical Procedures
Patient
Minor
Power of Attorney
Advance Directive
Consent
Medical Records
Emergency Contact
Healthcare Services
Witness
Mental Capacity
Religious Restrictions
Personal Information
Confidential Information
CNIC
Medical History
Attending Physician
Valid Period
Revocation
Medical Information Disclosure
Scope of Treatment
Religious Preferences
Liability and Indemnification
Confidentiality
Duration and Termination
Revocation Rights
Emergency Contact Authorization
Financial Responsibility
Information Access and Release
Governing Law
Witness Requirements
Guardian Authority
Treatment Limitations
Data Protection
Medical Records Access
Healthcare Provider Rights
Patient Rights
Force Majeure
Severability
Amendment and Modification
Healthcare
Emergency Services
Medical Insurance
Legal Services
Education (for student health services)
Corporate (for employee health programs)
Sports and Recreation
Travel and Tourism
Elderly Care
Child Care
Legal
Compliance
Emergency Medicine
Patient Administration
Risk Management
Medical Records
Patient Relations
Healthcare Operations
Quality Assurance
Medical Director
Hospital Administrator
Emergency Room Physician
Legal Counsel
Compliance Officer
Risk Manager
Healthcare Facility Manager
Patient Relations Manager
Medical Records Officer
Emergency Services Coordinator
School Nurse
Corporate Health Officer
Travel Medicine Specialist
Sports Medicine Physician
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