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1. Patient Information: Complete identification details of the patient including full name, IC/passport number, date of birth, address, and contact information
2. Authorization Grantor Details: Information about the person giving authorization (either patient or legal representative), including relationship to patient if not self
3. Healthcare Provider Information: Details of the hospital, clinic, or medical facility and primary healthcare provider(s)
4. Scope of Authorization: Clear description of the medical treatments, procedures, or services being authorized
5. Emergency Contact Information: Details of primary and secondary emergency contacts
6. Consent Declaration: Explicit statement of consent and acknowledgment of risks and benefits
7. Duration of Authorization: Validity period of the authorization and any conditions for renewal or termination
8. Financial Responsibility: Statement regarding payment obligations and insurance information
9. Signature Block: Space for signatures of all relevant parties with dates and witness provisions
1. Religious or Cultural Preferences: Section for specifying any religious or cultural considerations affecting treatment decisions, particularly relevant in Malaysia's multicultural context
2. Specific Treatment Exclusions: List of any procedures or treatments specifically not authorized
3. Interpreter Declaration: Required when the form needs to be explained in a language other than the written form
4. Mental Capacity Assessment: Required when there are questions about the patient's capacity to provide informed consent
5. Alternative Treatment Options: Detailed section about alternative treatments considered and rejected
6. Research Authorization: Optional consent for use of medical information in research or teaching
7. Telemedicine Consent: Additional authorization for virtual medical consultations and treatment
8. Photography/Recording Consent: Permission for medical photography or recording of procedures
1. Schedule A - Detailed Medical Procedure Description: Technical description of authorized medical procedures and associated risks
2. Schedule B - Cost Estimate: Breakdown of expected costs and financial obligations
3. Schedule C - Medical History Form: Detailed patient medical history including allergies, previous conditions, and current medications
4. Appendix 1 - Witness Requirements: Specific requirements for witness signatures based on procedure type
5. Appendix 2 - Glossary of Medical Terms: Definitions of medical terminology used in the authorization form
6. Appendix 3 - Patient Rights and Responsibilities: Summary of patient rights and responsibilities under Malaysian law
Healthcare
Insurance
Education
Sports and Recreation
Elderly Care
Child Care
Medical Tourism
Alternative Medicine
Emergency Services
Corporate Health Services
Legal
Compliance
Medical Records
Patient Services
Clinical Operations
Quality Assurance
Risk Management
Emergency Services
International Patient Services
Administrative Services
Medical Director
Hospital Administrator
Physician
Surgeon
Nurse Manager
Legal Counsel
Compliance Officer
Risk Manager
Medical Records Officer
Patient Services Coordinator
Insurance Coordinator
Clinical Operations Manager
Quality Assurance Manager
Emergency Department Director
Medical Tourism Coordinator
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