The Permission Medical Authorization Letter is a crucial document in Indonesian healthcare settings, designed to ensure continuous medical care and decision-making when an individual is unable to make their own healthcare decisions. This document becomes necessary in various situations, such as when parents need to authorize caregivers for their children's medical treatment, when elderly patients want to designate family members to manage their healthcare, or when individuals traveling abroad want to ensure their medical decisions can be handled by trusted representatives. The authorization letter must comply with Indonesian healthcare regulations, particularly Law No. 36 of 2009 on Health and Minister of Health Regulation No. 290/MENKES/PER/III/2008 regarding informed consent. It typically includes detailed information about both parties, specific authorized actions, duration of authority, and may require notarization for certain uses.
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1. Personal Information of Authorizer: Full legal name, ID number (KTP), date of birth, and contact details of the person granting authorization
2. Personal Information of Authorized Person: Full legal name, ID number (KTP), date of birth, and contact details of the person being granted medical authorization
3. Relationship Declaration: Statement of the relationship between the authorizer and authorized person
4. Scope of Authorization: Specific medical decisions and actions the authorized person can make, including any limitations
5. Duration of Authorization: Time period for which the authorization is valid
6. Emergency Contact Information: Additional emergency contacts and their contact details
7. Attestation and Signatures: Formal declaration of the authorization and signature blocks for all parties
1. Specific Medical Conditions: Details of existing medical conditions when authorization is for specific health issues
2. Healthcare Provider Information: Specific healthcare facilities or providers where the authorization will be used, if limited to certain facilities
3. Religious or Cultural Preferences: Specific religious or cultural considerations for medical treatment
4. Insurance Information: Health insurance details when authorization includes handling insurance matters
5. Revocation Clause: Specific terms for revoking the authorization before its expiration
1. Copy of Authorizer's ID: Certified copy of authorizer's KTP or passport
2. Copy of Authorized Person's ID: Certified copy of authorized person's KTP or passport
3. Family Card (Kartu Keluarga): Copy of family card if authorization is between family members
4. Medical History Summary: Brief summary of relevant medical history if authorization is for specific conditions
5. Witness Statements: Signed statements from witnesses verifying the authorization
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Insurance
Legal Services
Hospital Administration
Emergency Services
Elder Care
Child Care
Medical Tourism
Relevant Teams
Legal Affairs
Patient Services
Medical Records
Admissions
Risk Management
Compliance
Emergency Services
Insurance Coordination
Clinical Administration
Patient Relations
Relevant Roles
Medical Director
Hospital Administrator
Legal Compliance Officer
Healthcare Facility Manager
Medical Records Manager
Patient Services Coordinator
Emergency Department Supervisor
Admissions Manager
Insurance Coordinator
Risk Management Officer
Legal Affairs Director
Patient Relations Manager
Clinical Services Director
Healthcare Legal Counsel
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