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1. Personal Information (Persönliche Angaben): Patient's full legal name, date of birth, address, insurance information, and identification numbers
2. Healthcare Provider Details (Angaben zum Gesundheitsdienstleister): Name and contact information of the primary healthcare provider or medical facility
3. Scope of Authorization (Umfang der Vollmacht): Detailed description of what medical decisions and actions are being authorized
4. Duration of Authority (Gültigkeitsdauer): Specification of how long the authorization remains valid, including start and end dates if applicable
5. Data Protection Declaration (Datenschutzerklärung): GDPR-compliant statement regarding the processing and sharing of medical data
6. Revocation Rights (Widerrufsrecht): Clear explanation of the right to revoke the authorization and the process for doing so
7. Signatures and Declarations (Unterschriften und Erklärungen): Signature sections for all relevant parties with declarations of understanding
1. Emergency Contact Authorization (Notfallkontakt-Berechtigung): Additional section when emergency contacts need special authorization rights
2. Specific Treatment Authorization (Spezifische Behandlungsvollmacht): Used when authority is needed for specific medical procedures or treatments
3. International Validity (Internationale Gültigkeit): Added when the authority needs to be valid across international borders
4. Digital Communication Consent (Einwilligung zur digitalen Kommunikation): Optional section for authorizing digital communication and telemedicine
5. Insurance Authorization (Versicherungsvollmacht): Special authorization for dealing with health insurance matters
1. List of Authorized Procedures (Liste der autorisierten Verfahren): Detailed list of specific medical procedures covered by the authorization
2. Authorized Healthcare Providers (Autorisierte Gesundheitsdienstleister): List of specific healthcare providers or facilities authorized to provide treatment
3. Data Processing Consent Details (Details zur Datenverarbeitung): Detailed information about data processing procedures and authorized data recipients
4. Document Copies Required (Erforderliche Dokumentenkopien): List of identification and supporting documents that must be attached to the form
Healthcare
Medical Insurance
Pharmaceuticals
Elder Care
Mental Health Care
Rehabilitation Services
Emergency Medical Services
Outpatient Care
Hospital Administration
Medical Research
Legal
Compliance
Medical Administration
Patient Services
Records Management
Risk Management
Quality Assurance
Data Protection
Healthcare Operations
Patient Relations
Medical Director
Healthcare Administrator
Legal Compliance Officer
Data Protection Officer
Patient Care Coordinator
Medical Records Manager
Healthcare Facility Manager
Insurance Claims Specialist
Medical Secretary
Admissions Coordinator
Healthcare Legal Counsel
Patient Rights Advocate
Medical Ethics Officer
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