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1. Patient Information: Minor's full legal name, date of birth, NHI number, and contact details
2. Parent/Legal Guardian Information: Full details of the parent(s) or legal guardian(s) including contact information and relationship to the minor
3. Healthcare Provider Information: Details of the medical practice, hospital, or healthcare facility providing treatment
4. General Consent for Treatment: Standard authorization for routine medical care, examinations, and basic procedures
5. Emergency Treatment Authorization: Specific consent for emergency medical care when parent/guardian cannot be immediately contacted
6. Information Disclosure Authorization: Consent to share medical information with specified healthcare providers and relevant parties
7. Financial Responsibility: Acknowledgment of responsibility for payment of medical services
8. Attestation and Signatures: Formal declaration of understanding and agreement, with spaces for dated signatures of all relevant parties
1. Specific Treatment Authorizations: Additional specific consents for particular procedures or treatments that may be relevant to the minor's condition
2. Alternative Decision Maker: Designation of other adults authorized to consent to medical treatment in parent/guardian's absence
3. Cultural Considerations: Specific cultural or religious preferences that may affect medical treatment
4. Interpreter Declaration: Required when form is explained through an interpreter, including interpreter's confirmation of accurate translation
5. Mental Health Treatment Consent: Specific section for mental health treatment authorization where relevant
6. Photography/Recording Consent: Optional authorization for medical photography or recording for treatment or teaching purposes
1. Schedule A - Authorized Treatments: Detailed list of specific medical treatments and procedures being consented to
2. Schedule B - Authorized Representatives: List of other adults authorized to make medical decisions in parent/guardian's absence
3. Appendix 1 - Patient Rights: Summary of patient rights under NZ law and the Code of Health and Disability Services Consumers' Rights
4. Appendix 2 - Emergency Contacts: Comprehensive list of emergency contacts and their relationship to the minor
Healthcare
Medical Services
Pediatric Care
Emergency Services
Mental Health Services
Allied Health Services
School Health Services
Community Health
Primary Care
Hospital Services
Legal
Compliance
Medical Administration
Patient Services
Clinical Operations
Risk Management
Medical Records
Front Desk
Emergency Services
Pediatrics
Medical Doctor
Pediatrician
Nurse Practitioner
Registered Nurse
Healthcare Administrator
Practice Manager
Medical Receptionist
Emergency Department Physician
Clinical Director
Legal Compliance Officer
Risk Manager
Patient Services Coordinator
Medical Records Manager
Healthcare Facility Director
School Nurse
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