Informed Consent And Health Declaration Forms are essential documents in Indonesian healthcare settings, required under Law No. 36 of 2009 on Health and associated regulations. These forms serve dual purposes: obtaining patients' informed consent for medical procedures and collecting crucial health information. They are mandatory for most medical procedures in Indonesia and must be completed before any significant medical intervention. The documents protect both healthcare providers and patients by ensuring transparent communication about medical procedures, risks, and current health status. They must comply with Indonesian data protection laws and healthcare regulations, including requirements for witness signatures and proper documentation. These forms are particularly crucial in cases involving surgical procedures, specialized treatments, or when collecting sensitive health information.
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 identification details of the patient including full name, date of birth, ID number (NIK), address, and contact information
2. Healthcare Provider Information: Details of the medical facility, attending physician(s), and relevant medical staff involved
3. Current Health Status Declaration: Patient's declaration of current health conditions, symptoms, and medical history
4. Medical Procedure Information: Detailed description of the proposed medical procedure, treatment, or examination
5. Risks and Benefits: Clear explanation of potential risks, complications, and expected benefits of the procedure or treatment
6. Alternative Treatment Options: Information about alternative treatments or procedures available to the patient
7. Patient Rights and Obligations: Statement of patient's rights to information, privacy, and ability to withdraw consent, along with their obligations
8. Consent Declaration: Formal statement of consent, confirming the patient's understanding and voluntary agreement
9. Confidentiality Statement: Information about how patient data will be protected and used in accordance with Indonesian privacy laws
10. Signatures and Witnesses: Space for signatures of patient/legal representative, healthcare provider, and witnesses as required by Indonesian law
1. Interpreter Declaration: Required when the patient needs language interpretation services, including interpreter's confirmation of accurate translation
2. Legal Representative Authorization: Required when the patient is a minor, unconscious, or legally incompetent to provide consent
3. Religious/Cultural Considerations: Special section for addressing specific religious or cultural requirements affecting medical care
4. Research Participation Consent: Required when the procedure is part of a medical research study
5. Photography/Video Consent: Optional authorization for medical photography or video recording
6. Financial Responsibility: Details of payment obligations and insurance coverage when relevant to the procedure
7. Emergency Contact Information: Additional contact information for emergency situations
8. Travel History Declaration: Required during infectious disease outbreaks or pandemic situations
1. Medical History Form: Detailed questionnaire about patient's past medical conditions, surgeries, allergies, and medications
2. Procedure-Specific Information Sheet: Detailed technical information about specific medical procedures
3. Risk Assessment Checklist: Standardized checklist for assessing patient-specific risk factors
4. Medication List: Current medications, supplements, and herbal remedies being taken by the patient
5. Post-Procedure Care Instructions: Detailed instructions for post-procedure care and recovery
6. Emergency Contact Form: Comprehensive emergency contact information and preferred hospital choices
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Hospitals
Clinics
Dental Practices
Research Institutions
Pharmaceutical Clinical Trials
Medical Tourism
Elder Care
Mental Health Services
Rehabilitation Services
Alternative Medicine
Diagnostic Centers
Relevant Teams
Legal Affairs
Medical Administration
Patient Services
Quality Assurance
Risk Management
Compliance
Medical Records
Clinical Operations
Data Protection
Patient Relations
Healthcare Operations
Relevant Roles
Medical Director
Chief Medical Officer
Hospital Administrator
Clinic Manager
Legal Compliance Officer
Healthcare Risk Manager
Medical Practitioner
Nurse Manager
Patient Services Coordinator
Quality Assurance Manager
Medical Records Officer
Healthcare Legal Advisor
Data Protection Officer
Patient Rights Advocate
Clinical Research Coordinator
Medical Secretary
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.
Download
Informed Consent Form
Indonesian-compliant Informed Consent Form for medical procedures or research participation, meeting local healthcare regulations and patient rights requirements.
Download
Beauty Consent Form
An Indonesian-law compliant consent form for beauty treatments and procedures, ensuring informed client consent and legal protection for service providers.
Download
Aesthetic Consent Form
An Indonesian-compliant informed consent form for aesthetic procedures, meeting local healthcare regulations and protecting both provider and patient interests.
Download
Iv Consent Form
An Indonesian-compliant informed consent form for IV procedures, meeting local healthcare regulations and ensuring documented patient consent.
Download
Consent Document
An Indonesian law-compliant consent document for personal data collection and processing under the PDP Law.
Download
Patient Consent Form For Treatment
An Indonesian-compliant medical consent form documenting patient authorization for treatment, aligned with local healthcare regulations.
Download
Travel Permission Letter For Minor
An Indonesian legal document authorizing minor travel, compliant with national child protection and immigration laws.
Download
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.
Download
Certificate Of Consent Form
An Indonesian law-compliant document that formally records and validates explicit consent for specific activities or procedures.
Download
Permission Letter From Parents
An Indonesian law-compliant document where parents/guardians authorize specific activities or services for their minor child.
Download
Employee Media Release Form
An Indonesian law-compliant consent form authorizing employer use of employee media content, including images and recordings, for company purposes.
Download
Photo Authorization Form
An Indonesian law-compliant authorization form for photographic usage rights, ensuring proper consent and data protection under local regulations.
Download
Waxing Consent Form
An Indonesian-compliant consent form for waxing services that documents client approval and understanding of the procedure, risks, and aftercare requirements.
Download
Sports Consent Form
An Indonesian-compliant consent form for sports participation that covers risk acknowledgment, medical declarations, and liability releases under Indonesian sports law.
Download
Reference Consent Form
An Indonesian-law compliant consent form authorizing the release of employment references, aligned with local PDP and employment regulations.
Download
Participant Consent Form
An Indonesian-compliant legal document for obtaining informed consent from research participants, adhering to local data protection and research regulations.
Download
Nail Consent Form
An Indonesian-compliant consent form for nail treatments, documenting client approval and treatment details while meeting local health and safety regulations.
Download
Data Privacy Consent Form
An Indonesian law-compliant Data Privacy Consent Form for obtaining explicit consent for personal data processing under UU PDP requirements.
Download
Consent Declaration Form
An Indonesian law-compliant consent declaration form for personal data collection and processing under the PDP Law.
Download
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.
Download
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.
Download
Social Media Consent Form
An Indonesian law-compliant consent form for social media content usage and personal data processing, aligned with PDP Law requirements.
Download
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.
Download
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.
Download
Parental Consent Letter
An Indonesian law-compliant document allowing parents/guardians to authorize specific permissions regarding their minor child.
Download
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.
Download
Mutual Consent Agreement
An Indonesian law-governed agreement documenting mutual understanding and consent between parties, establishing agreed terms and conditions.
Download
Media Permission Form
An Indonesian-compliant legal document granting permission for media content usage, subject to Indonesian copyright and data protection laws.
Download
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.
Download
Generic Consent Form
An Indonesian law-compliant consent form template for documenting explicit permission from individuals, adhering to PDP Law requirements.
Download
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.
Download
Consent And Indemnity Form
An Indonesian law-governed document combining explicit consent provisions with indemnification terms to manage risk and liability between parties.
Download
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.
Download
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.
Download
Consent For Surgery Form
An Indonesian-compliant surgical consent form documenting patient authorization and understanding of proposed surgical procedures, risks, and benefits.
Download
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.
Download
Consent For Access To Information Form
An Indonesian law-compliant consent form for authorized access to personal information, aligned with the PDP Law requirements.
Download
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.
Download
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.
Download
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)