Emergency Medical Authorization Form

Emergency Medical Authorization Form Template for Denmark

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Document background

The Emergency Medical Authorization Form is a critical document used in Denmark when immediate medical decisions may be required in situations where a patient is unable to provide direct consent. This document, governed by Danish healthcare legislation including the Sundhedsloven, enables healthcare providers to deliver necessary emergency treatment while ensuring compliance with legal requirements and patient preferences. It contains essential medical history, contact information, and specific authorizations, serving as a vital tool in emergency medical situations. The form is particularly important for individuals with chronic conditions, elderly patients, minors, or anyone who wants to ensure their medical preferences are respected in emergency situations.

Suggested Sections

1. Patient Information: Essential personal details including full name, CPR number (Danish personal ID), address, and contact information

2. Emergency Contacts: Primary and secondary emergency contact details with full names, relationships, and multiple contact methods

3. Medical History Summary: Brief overview of relevant medical conditions, allergies, and current medications

4. Authorization Statement: Clear statement of medical treatment authorization, including scope of permitted treatments and procedures

5. Authorized Representatives: Names and details of persons authorized to make medical decisions if the primary contact is unavailable

6. Consent for Information Sharing: Authorization for sharing medical information with specified healthcare providers and authorized representatives

7. Duration and Validity: Specification of the time period for which the authorization is valid

8. Execution: Signature sections for the patient or legal guardian, witnesses, and date of execution

Optional Sections

1. Religious or Cultural Preferences: Specific religious or cultural considerations that may affect medical treatment decisions

2. Organ Donation Preferences: Patient's wishes regarding organ donation in case of death

3. Specific Treatment Restrictions: Any specific treatments or procedures that are explicitly not authorized

4. Insurance Information: Details of health insurance coverage and policy information

5. Language Preferences: Preferred language for communication and whether an interpreter is needed

6. Digital Access Authorization: Authorization for digital access to medical records and online health platforms

Suggested Schedules

1. Schedule A - Detailed Medical History: Comprehensive list of medical conditions, surgeries, and treatments

2. Schedule B - Current Medications: Complete list of current medications, dosages, and prescribing physicians

3. Schedule C - Healthcare Provider Contacts: List of current healthcare providers and their contact information

4. Schedule D - Identification Documents: Copies of relevant identification documents and insurance cards

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