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1. Parties: Identification of the person giving authorization (grantor), the person receiving treatment (if different), and the healthcare provider/facility
2. Background: Context of the authorization and relationship between parties if the grantor is not the patient
3. Definitions: Key terms used in the document including 'medical treatment', 'emergency care', 'healthcare provider', etc.
4. Scope of Authorization: Specific medical treatments, procedures, and services being authorized
5. Duration of Authorization: Time period for which the authorization is valid
6. Emergency Contact Information: Details of primary and secondary emergency contacts
7. Consent to Treatment: Express authorization for medical treatment and acknowledgment of understanding
8. Release of Information: Authorization to release medical information to specified parties
9. Financial Responsibility: Statement regarding responsibility for medical expenses
10. Revocation Rights: Process and rights for revoking the authorization
11. Governing Law: Specification that Nigerian law governs the authorization
12. Execution: Signature blocks and witness requirements
1. Minor Patient Provisions: Additional provisions when the patient is under 18, including parental rights and responsibilities
2. Special Treatment Authorizations: Specific provisions for specialized treatments like surgery, anesthesia, or experimental procedures
3. Religious/Cultural Preferences: Specific instructions regarding religious or cultural considerations in treatment
4. Medical History Authorization: Permission to access and share previous medical records
5. Translation Certificate: Required when the document has been translated from English to local languages
6. Mental Health Treatment: Special provisions for mental health treatment and consent
7. Blood Transfusion Authorization: Specific authorization or restriction for blood transfusions
1. Schedule A - Medical History: Patient's relevant medical history, allergies, and current medications
2. Schedule B - Authorized Procedures: Detailed list of specific procedures being authorized
3. Schedule C - Authorized Healthcare Providers: List of specific healthcare providers or facilities authorized to provide treatment
4. Appendix 1 - Emergency Protocols: Specific instructions for emergency situations
5. Appendix 2 - Insurance Information: Details of relevant insurance coverage and policies
Healthcare
Insurance
Education
Sports & Recreation
Emergency Services
Legal Services
Social Services
Corporate Health & Wellness
Travel & Tourism
Aged Care
Legal
Compliance
Risk Management
Patient Services
Medical Records
Emergency Services
Insurance Processing
Human Resources
Clinical Operations
Administrative Services
Medical Director
Hospital Administrator
Legal Counsel
Compliance Officer
Risk Manager
Healthcare Provider
Nurse Manager
Emergency Room Director
Patient Services Coordinator
Insurance Coordinator
Medical Records Manager
School Nurse
Corporate Health Officer
Sports Medicine Physician
Human Resources Manager
Travel Medical Coordinator
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