Proxy Consent Form Template for Singapore

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Key Requirements PROMPT example:

Proxy Consent Form

"I need a Proxy Consent Form that authorizes my sister to make healthcare decisions on my behalf while I'm working overseas from March 2025 to December 2025, with specific provisions for emergency medical treatment and access to my medical records at Singapore General Hospital."

Document background

The Proxy Consent Form is a critical legal instrument in Singapore's healthcare and personal welfare framework. It is utilized when an individual needs to delegate decision-making authority to a trusted representative, particularly for healthcare decisions. The document must comply with Singapore's Mental Capacity Act and related healthcare legislation, requiring proper execution, witnessing, and clear specification of the scope of authority granted. This form is particularly relevant when individuals anticipate potential future incapacity or wish to ensure continuity of decision-making in their healthcare management.

Suggested Sections

1. Personal Information: Details of the person giving consent (principal) and the appointed proxy

2. Scope of Authority: Specific powers and limitations granted to the proxy

3. Duration: Time period for which the proxy consent is valid

4. Declaration: Statement of understanding and voluntary consent

5. Witness Details: Information and signatures of required witnesses

Optional Sections

1. Medical Conditions: Specific medical conditions relevant to the proxy consent, used when consent relates to healthcare decisions

2. Special Instructions: Additional specific instructions or restrictions, used when particular circumstances need to be addressed

3. Revocation Terms: Conditions under which the proxy consent can be revoked, used when specific revocation terms are desired

Suggested Schedules

1. Medical Records: Relevant medical history or reports

2. Capacity Assessment: Documentation of principal's mental capacity assessment if required

3. Identification Documents: Copies of relevant identification documents for principal and proxy

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Elder Care
Legal Services
Insurance

Relevant Teams

Legal
Medical Administration
Compliance
Patient Services
Risk Management

Relevant Roles

Medical Director
Healthcare Administrator
Legal Counsel
Compliance Officer
Patient Care Coordinator

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Let's create your Proxy Consent Form

Authors

Alex Denne

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