Patient Release Form

Patient Release Form for Indonesia

Patient Release Form Template for Indonesia

A Patient Release Form is a critical legal and medical document used in Indonesian healthcare facilities to formally document a patient's discharge from medical care. The document complies with Indonesian healthcare regulations, particularly Minister of Health Regulation No. 4 of 2018 and Law No. 29 of 2004 on Medical Practice. It serves multiple purposes: documenting the patient's condition at discharge, providing post-discharge care instructions, confirming the patient's understanding of these instructions, and establishing a legal record of the discharge process. The form includes essential patient information, treatment summary, discharge instructions, and necessary signatures from all relevant parties, while ensuring compliance with Indonesian medical documentation requirements and patient rights regulations.

Your data doesn't train Genie's AI

You keep IP ownership of your information

Generate a Bespoke Document

1. Select your governing law:

2. Enter your key requirements:

3. Create your document to edit, review or download

Download a Standard Template

Get our Indonesia-compliant Patient Release Form

4.6 / 5

4.8 / 5

Alternatively: Run an advanced review of an existing
Patient Release Form

Let ��Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.

What is a Patient Release Form?

The Patient Release Form serves as a crucial document in Indonesian healthcare settings, bridging medical care documentation and legal requirements. It is designed to comply with Indonesian healthcare regulations, particularly focusing on patient rights, medical documentation, and healthcare facility obligations. The document becomes necessary when a patient is being discharged from a healthcare facility, whether after routine treatment, emergency care, or extended hospitalization. It plays a vital role in risk management for healthcare facilities while ensuring proper documentation of patient care and discharge instructions. The form must adhere to strict documentation requirements under Indonesian law while remaining accessible and understandable to patients and their families.

What sections should be included in a Patient Release Form?

1. Patient Information: Complete identification details of the patient including full name, medical record number, date of birth, and ID number

2. Healthcare Facility Information: Name and address of the hospital/healthcare facility, department, and treating physician(s)

3. Admission and Treatment Summary: Brief summary of the reason for admission, treatment received, and current condition

4. Discharge Instructions: Detailed instructions for post-discharge care, medication schedules, and activity restrictions

5. Follow-up Care: Scheduled follow-up appointments, recommended consultations, and emergency contact information

6. Release Declaration: Formal statement confirming patient's voluntary discharge and understanding of instructions

7. Acknowledgment and Signatures: Signature sections for patient/guardian, attending physician, and witness with date and time

What sections are optional to include in a Patient Release Form?

1. Against Medical Advice Release: Additional declarations and warnings when patient chooses to leave against medical advice

2. Transfer Information: Details of transfer arrangements if patient is being transferred to another facility

3. Special Care Instructions: Additional detailed instructions for patients with complex medical conditions or special care needs

4. Insurance and Billing: Information regarding payment status and insurance claims if relevant to discharge

5. Guardian Authorization: Additional section when patient is a minor or unable to provide consent

6. Interpreter Declaration: For cases where an interpreter was used to explain the release form

What schedules should be included in a Patient Release Form?

1. Medication Schedule: Detailed list of prescribed medications, dosages, and administration schedules

2. Home Care Instructions: Detailed instructions for wound care, exercises, or other specific care requirements

3. Follow-up Appointment Schedule: Calendar of scheduled follow-up appointments and recommended check-ups

4. Equipment Instructions: Instructions for any medical equipment patient needs to use at home

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Cost

Free to use

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Medical Services

Hospital Administration

Primary Care

Emergency Medicine

Specialized Medical Care

Healthcare Insurance

Medical Records Management

Relevant Teams

Medical Administration

Patient Services

Legal & Compliance

Quality Assurance

Risk Management

Medical Records

Nursing Administration

Patient Care Coordination

Healthcare Operations

Administrative Services

Relevant Roles

Hospital Administrator

Medical Director

Head Nurse

Attending Physician

Resident Doctor

Nursing Staff

Medical Records Officer

Patient Services Coordinator

Quality Assurance Manager

Risk Management Officer

Healthcare Facility Manager

Compliance Officer

Administrative Assistant

Patient Care Coordinator

Find the exact document you need

No matches found.

Title And Lien Release

An Indonesian law-governed document that releases security interests over property and confirms clear title transfer, subject to local property and security regulations.

��������Ƶ

How Cambridge United Uses ��������Ƶ to Speed Up Player Signings and Slash Legal Costs

Generate a Bespoke Document

Download a Standard Template

What is a Patient Release Form?

What sections should be included in a Patient Release Form?

What sections are optional to include in a Patient Release Form?

What schedules should be included in a Patient Release Form?

Authors

Alex Denne

Jurisdiction

Publisher

Document Type

Sector

Cost

Find the exact document you need

Title And Lien Release

Medical Work Release Form

Online Release Form

Authorization To Release Employee Information Form

Motor Vehicle Record Disclosure And Release Form

Consent Form For Release Of Information

Tenant Release Form

Promissory Note Release

Minor Release Form

Medical Photo Consent Form

Audio Release Form

Medical Treatment Authorization And Consent Form

Release Of Information Form Mental Health

Revocation Of Authorization To Disclose Health Information

Participant Release Form

Customer Release Form

Landlord Release Form

Medical Treatment Release Form

Termination Of Account Letter

Gym Disclaimer Form

Release Of Information

Photography Consent Form

Release Of Liability

Authorization To Release Confidential Information

Patient Information Release Form

Participation Waiver Form

Babysitter Medical Consent Form

Consent To Share Information

Release Request Form

Personal Release And Consent Form

New Release Form

Injury Release Form

Employee Key Release Form

Temporary Guardian Medical Release Form

Physical Therapy Release Form

Medical Release Form To Return To Work

Hospital Release Form

Driving Record Consent Form

Background Release Form

�ұ�Ծ���’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security:

Use Cases

Generate Legal Docs Free

��Ƶ

How Cambridge United Uses ��Ƶ to Speed Up Player Signings and Slash Legal Costs

�ұ�Ծ��’s Security Promise