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Consent To Treat Minor Form
1. Patient Information: Minor's full name, date of birth, address, and personal identification number (CPR number)
2. Parent/Guardian Information: Full names, contact details, and relationship to minor of all legal guardians, including documentation of custody arrangements if relevant
3. Emergency Contacts: Alternative contacts if parents/guardians cannot be reached, including their relationship to the minor
4. Medical History: Brief overview of relevant medical history, allergies, current medications, and existing conditions
5. Consent Authorization: Specific medical treatments and procedures being authorized, including routine examinations, emergency care, and administration of medications
6. Duration of Authorization: Time period for which the consent is valid, including expiration date if applicable
7. Privacy Notice: GDPR-compliant statement about how medical information will be collected, used, and protected
8. Signature Block: Space for dated signatures of all required parties, including witness signatures if required
1. Special Medical Instructions: Used when the minor has specific medical needs, dietary restrictions, or requires special care instructions
2. Religious or Cultural Preferences: Include when there are specific religious or cultural considerations that may affect medical treatment
3. Telehealth Consent: Added when remote medical consultations might be needed
4. Translation Declaration: Required when the form has been translated from Danish, certifying accuracy of translation
5. Custody Documentation: Needed in cases of divorced parents, shared custody, or legal guardianship arrangements
6. Mental Health Treatment Authorization: Include when mental health services might be needed
1. Schedule A - List of Authorized Treatments: Detailed list of specific medical procedures and treatments being authorized
2. Schedule B - Medical History Form: Detailed medical history questionnaire to be completed by parents/guardians
3. Appendix 1 - Emergency Protocol: Step-by-step protocol for emergency situations when parents cannot be reached
4. Appendix 2 - Healthcare Provider Information: List of approved healthcare providers and facilities covered by this consent
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