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Medical Authority Form
1. Patient Information: Full legal name, CPR number (Danish personal identification number), address, and contact details of the patient granting authority
2. Authorized Representative: Full legal name, CPR number, address, and contact details of the person(s) being granted medical authority
3. Scope of Authority: Detailed specification of what medical decisions and information the authorized representative can access and make decisions about
4. Duration of Authority: Specification of the time period for which the authority is valid, including start date and end date if applicable
5. Emergency Contact Information: Additional emergency contacts and their order of priority
6. Revocation Rights: Clear explanation of the patient's right to revoke the authority and the process for doing so
7. Signatures and Witnessing: Space for required signatures, including patient, authorized representative(s), and witnesses if required
1. Specific Medical Conditions: Details of specific medical conditions that require special consideration or specific instructions for the authorized representative
2. Treatment Preferences: Patient's specific preferences for certain types of medical treatments or procedures
3. Alternative Representatives: Designation of alternative representatives if the primary representative is unavailable
4. Digital Access Authorization: Specific permissions for accessing digital health records and online medical platforms
5. International Validity: Additional provisions for the authority to be valid in specific foreign jurisdictions
6. Language Preference: Specification of preferred language for medical communication when relevant in multilingual situations
1. Schedule A - Specific Medical Procedures: Detailed list of specific medical procedures for which authority is granted or explicitly withheld
2. Schedule B - Healthcare Providers: List of healthcare providers and facilities covered by the authority
3. Schedule C - Identification Documents: Copies of identification documents for both patient and representative(s)
4. Appendix 1 - Glossary of Medical Terms: Definitions of medical terms used in the document for clarity
5. Appendix 2 - Revocation Form: Standard form for revoking the medical authority if needed
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