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1. Minor's Information: Complete details of the minor including full name, date of birth, nationality, and Qatar ID number
2. Authorized Person's Details: Full information about the person authorized to give consent, including their relationship to the minor and contact details
3. Scope of Authorization: Clear description of the medical treatments and procedures being authorized, including routine care, emergency treatment, and any specific procedures
4. Duration of Authorization: Specific timeframe for which the authorization is valid
5. Emergency Contacts: List of emergency contacts, including parents/guardians and their contact information
6. Medical History: Brief medical history including allergies, current medications, and relevant medical conditions
7. Declaration and Signature: Formal declaration of authority and understanding, with signature blocks for authorized person and witness
1. Special Instructions: Additional specific instructions regarding the minor's care or treatment preferences
2. Religious or Cultural Considerations: Any religious or cultural preferences that should be considered in medical treatment
3. Insurance Information: Details of medical insurance coverage and payment responsibilities
4. Travel Authorization: Authorization for medical treatment during travel, if the document is being used for travel purposes
5. Temporary Guardian Appointment: Section appointing a temporary guardian for medical decisions, if applicable
1. Schedule A - Medical History Form: Detailed medical history form including past surgeries, vaccinations, and family medical history
2. Schedule B - Authorized Treatments List: Specific list of treatments and procedures that are pre-authorized
3. Schedule C - Emergency Contact Protocol: Detailed protocol for contacting various parties in different types of medical situations
4. Appendix 1 - Supporting Documents: Copies of relevant identity documents, power of attorney, or court orders if applicable
5. Appendix 2 - Medical Facility List: List of approved medical facilities where the authorization is intended to be used
Healthcare
Medical Services
Education
Sports & Recreation
Emergency Services
Child Care Services
Legal Services
Insurance
Social Services
Legal
Compliance
Medical Administration
Emergency Medicine
Pediatrics
Risk Management
Medical Records
Patient Services
Social Services
Medical Director
Healthcare Administrator
School Principal
School Nurse
Camp Director
Sports Coach
Legal Counsel
Compliance Officer
Risk Manager
Emergency Room Doctor
Pediatrician
Family Physician
Medical Records Manager
Healthcare Facility Manager
Social Worker
Child Protection Officer
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