The Emergency Medical Authorization Form is a critical legal document used in Indonesia when immediate medical treatment may be necessary and direct patient consent might not be possible. This document, governed by Indonesian healthcare regulations including Law No. 36 of 2009 on Health and Minister of Health Regulation No. 290/MENKES/PER/III/2008, enables healthcare providers to deliver emergency medical care while protecting both patient rights and healthcare provider liability. The form designates authorized representatives who can make time-sensitive medical decisions, includes essential patient medical information, and specifies the scope of permitted treatments. It is particularly vital for individuals with pre-existing conditions, elderly patients, those engaging in high-risk activities, or anyone who wants to ensure smooth access to emergency care within the Indonesian healthcare system.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Patient Information: Complete details of the patient including full legal name, date of birth, national ID number (NIK), address, and contact information
2. Authorized Representatives: Details of primary and secondary representatives authorized to make medical decisions, including their relationship to the patient and contact information
3. Emergency Contacts: List of people to be contacted in emergency situations, in order of priority
4. Medical Consent Authorization: Explicit authorization for medical treatment, procedures, and interventions in emergency situations
5. Scope of Authority: Detailed description of the medical decisions and treatments that can be authorized, including life-saving procedures
6. Healthcare Provider Rights: Authorization for healthcare providers to perform necessary emergency procedures and treatments
7. Duration and Validity: Period for which the authorization remains valid and conditions for renewal
8. Governing Law: Statement that the form is governed by Indonesian law and relevant healthcare regulations
9. Execution: Signature sections for the patient and/or authorized representatives, with witness requirements
1. Specific Medical Conditions: Details of any existing medical conditions, allergies, or specific health concerns that emergency providers should be aware of
2. Religious/Cultural Preferences: Any specific religious or cultural considerations that should be taken into account during medical treatment
3. Organ Donation Authorization: Optional section for indicating organ donation preferences in critical situations
4. Insurance Information: Details of health insurance coverage and payment arrangements for emergency medical care
5. Do Not Resuscitate (DNR) Instructions: Specific instructions regarding life-support measures, if applicable
6. Foreign Language Requirements: Translation requirements or language preferences for non-Indonesian speaking patients
1. Medical History Summary: Brief summary of relevant medical history, current medications, and allergies
2. Contact Information List: Comprehensive list of all relevant contact persons with their details and roles
3. Healthcare Facility Preferences: List of preferred hospitals or healthcare facilities, if any
4. Medication List: Current medications, dosages, and known drug allergies
5. Insurance Documentation: Copies of relevant insurance cards and coverage information
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Insurance
Emergency Services
Legal Services
Healthcare Administration
Medical Tourism
Corporate Health Services
Educational Institutions
Sports and Recreation
Senior Care Services
Relevant Teams
Legal
Compliance
Risk Management
Human Resources
Emergency Services
Patient Administration
Medical Records
International Relations
Student Services
Employee Benefits
Safety and Security
Customer Service
Relevant Roles
Hospital Administrator
Emergency Room Physician
Medical Director
Legal Compliance Officer
Risk Management Officer
Human Resources Manager
School Principal
Corporate Safety Officer
Insurance Claims Manager
Healthcare Facility Manager
Medical Records Officer
Patient Services Coordinator
Employee Benefits Manager
Sports Facility Manager
Tour Operator
International Student Coordinator
Find the exact document you need
Informed Consent And Health Declaration Form
An Indonesian-law compliant combined informed consent and health declaration document for medical procedures and treatments, meeting national healthcare regulatory requirements.
find out more
Informed Consent Form
Indonesian-compliant Informed Consent Form for medical procedures or research participation, meeting local healthcare regulations and patient rights requirements.
find out more
Beauty Consent Form
An Indonesian-law compliant consent form for beauty treatments and procedures, ensuring informed client consent and legal protection for service providers.
find out more
Aesthetic Consent Form
An Indonesian-compliant informed consent form for aesthetic procedures, meeting local healthcare regulations and protecting both provider and patient interests.
find out more
Iv Consent Form
An Indonesian-compliant informed consent form for IV procedures, meeting local healthcare regulations and ensuring documented patient consent.
find out more
Consent Document
An Indonesian law-compliant consent document for personal data collection and processing under the PDP Law.
find out more
Patient Consent Form For Treatment
An Indonesian-compliant medical consent form documenting patient authorization for treatment, aligned with local healthcare regulations.
find out more
Travel Permission Letter For Minor
An Indonesian legal document authorizing minor travel, compliant with national child protection and immigration laws.
find out more
Consent Permission Letter
An Indonesian law-compliant formal letter documenting explicit authorization from one party to another, establishing legal consent for specific actions or purposes.
find out more
Certificate Of Consent Form
An Indonesian law-compliant document that formally records and validates explicit consent for specific activities or procedures.
find out more
Permission Letter From Parents
An Indonesian law-compliant document where parents/guardians authorize specific activities or services for their minor child.
find out more
Employee Media Release Form
An Indonesian law-compliant consent form authorizing employer use of employee media content, including images and recordings, for company purposes.
find out more
Photo Authorization Form
An Indonesian law-compliant authorization form for photographic usage rights, ensuring proper consent and data protection under local regulations.
find out more
Waxing Consent Form
An Indonesian-compliant consent form for waxing services that documents client approval and understanding of the procedure, risks, and aftercare requirements.
find out more
Sports Consent Form
An Indonesian-compliant consent form for sports participation that covers risk acknowledgment, medical declarations, and liability releases under Indonesian sports law.
find out more
Reference Consent Form
An Indonesian-law compliant consent form authorizing the release of employment references, aligned with local PDP and employment regulations.
find out more
Participant Consent Form
An Indonesian-compliant legal document for obtaining informed consent from research participants, adhering to local data protection and research regulations.
find out more
Nail Consent Form
An Indonesian-compliant consent form for nail treatments, documenting client approval and treatment details while meeting local health and safety regulations.
find out more
Data Privacy Consent Form
An Indonesian law-compliant Data Privacy Consent Form for obtaining explicit consent for personal data processing under UU PDP requirements.
find out more
Consent Declaration Form
An Indonesian law-compliant consent declaration form for personal data collection and processing under the PDP Law.
find out more
Video Consent And Release Form
An Indonesian law-compliant consent form for video recording and usage rights, protecting both content creators and participants under local data protection regulations.
find out more
Statement Of Consent
An Indonesian law-compliant document recording explicit permission for specific actions or data processing, governed by the Civil Code and Personal Data Protection Law.
find out more
Social Media Consent Form
An Indonesian law-compliant consent form for social media content usage and personal data processing, aligned with PDP Law requirements.
find out more
Personal Information Consent Form
An Indonesian law-compliant consent form for personal data collection and processing under the PDP Law, ensuring legal data handling and subject rights protection.
find out more
Permission To Treat Form
An Indonesian-compliant medical consent form documenting patient authorization for healthcare treatment, aligned with local health regulations and patient rights requirements.
find out more
Parental Consent Letter
An Indonesian law-compliant document allowing parents/guardians to authorize specific permissions regarding their minor child.
find out more
Parent Consent Form For Work
An Indonesian legal document providing parental/guardian authorization for minor employment, ensuring compliance with national labor laws and child protection regulations.
find out more
Mutual Consent Agreement
An Indonesian law-governed agreement documenting mutual understanding and consent between parties, establishing agreed terms and conditions.
find out more
Media Permission Form
An Indonesian-compliant legal document granting permission for media content usage, subject to Indonesian copyright and data protection laws.
find out more
Letter Of Consent Form
An Indonesian-law governed document that formally captures explicit permission or authorization from an individual or entity for specific actions or uses, ensuring compliance with local consent and data protection regulations.
find out more
Generic Consent Form
An Indonesian law-compliant consent form template for documenting explicit permission from individuals, adhering to PDP Law requirements.
find out more
Employee Consent Letter
An Indonesian-law governed document obtaining explicit employee consent for specific workplace actions or data usage, complying with local labor and data protection laws.
find out more
Consent And Indemnity Form
An Indonesian law-governed document combining explicit consent provisions with indemnification terms to manage risk and liability between parties.
find out more
Massage Consent Form
An Indonesian-compliant consent form for massage services that documents client approval, health information, and data privacy agreements under local healthcare regulations.
find out more
Consent Letter For Rent Agreement
An Indonesian law-compliant formal letter providing authorized consent for rental arrangements, incorporating local property regulations and civil code requirements.
find out more
Consent For Surgery Form
An Indonesian-compliant surgical consent form documenting patient authorization and understanding of proposed surgical procedures, risks, and benefits.
find out more
Filming Permission Form
An Indonesian law-governed permission form authorizing filming activities at specific locations, establishing terms and conditions for film production while ensuring regulatory compliance.
find out more
Consent For Access To Information Form
An Indonesian law-compliant consent form for authorized access to personal information, aligned with the PDP Law requirements.
find out more
Spa Consent Form
An Indonesian-law compliant spa consent form capturing client information, medical history, and treatment authorizations while ensuring regulatory compliance with local spa service requirements.
find out more
Photography Consent And Release Form
An Indonesian law-compliant consent and release form for photography services, protecting both photographer and subject rights under local data protection and copyright laws.
find out more
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)