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1. Letter Header: Official letterhead including date, reference number, and subject line of the authorization
2. Authorizing Doctor's Details: Complete identification of the authorizing doctor including full name, medical license number, specialization, and current practice location
3. Authorized Party's Details: Complete identification of the person/entity being authorized including full name, position, and relevant identification numbers
4. Scope of Authorization: Clear and specific description of what medical activities or responsibilities are being authorized
5. Duration of Authorization: Specific time period for which the authorization is valid, including start and end dates
6. Legal Declaration: Statement confirming the legal basis of the authorization under Indonesian medical practice laws
7. Signature Block: Space for authorizing doctor's signature, stamp, and date of signing
1. Supervisory Provisions: Include when the authorization requires specific oversight or reporting requirements
2. Emergency Protocols: Include when authorization covers emergency medical situations
3. Limitation of Authority: Include when specific procedures or decisions are explicitly excluded from the authorization
4. Revocation Clause: Include when specific conditions for revoking the authorization need to be stated
5. Witness Section: Include when additional verification of the authorization is required
1. Copy of Medical License: Attached copy of the authorizing doctor's valid medical license
2. Professional Credentials: Copies of relevant professional certificates or credentials
3. Facility Approval: If applicable, approval from the medical facility where the authorization will be exercised
4. Specific Procedures List: Detailed list of specific medical procedures covered by the authorization, if applicable
Healthcare
Medical Services
Hospital Administration
Clinical Practice
Medical Education
Public Health
Private Medical Practice
Emergency Medical Services
Legal Affairs
Medical Administration
Compliance
Clinical Operations
Quality Assurance
Medical Records
Risk Management
Healthcare Operations
Professional Standards
Documentation
Medical Doctor
Specialist Physician
Hospital Administrator
Clinical Director
Department Head
Medical Supervisor
Resident Doctor
Chief Medical Officer
Healthcare Facility Manager
Medical Practice Manager
Compliance Officer
Legal Affairs Officer
Medical Board Secretary
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