The Temporary Guardian Medical Release Form is a critical legal instrument in Indonesian family and healthcare law, designed for situations where parents or legal guardians need to delegate medical decision-making authority for their minor child to a temporary guardian. This document becomes essential when parents are traveling, temporarily incapacitated, or otherwise unable to make immediate medical decisions for their child. The form must comply with Indonesian Civil Code requirements and Child Protection Law No. 23 of 2002, while also adhering to healthcare regulations under Law No. 36 of 2009 on Health. It typically includes detailed medical history, insurance information, emergency contacts, and specific authorizations for medical procedures, ensuring that the child can receive necessary medical care while protecting both the child's interests and the healthcare providers' legal positions.
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1. Identification of Parties: Details of the parent(s)/legal guardian(s), temporary guardian, and the minor child including full legal names, ID numbers, addresses, and contact information
2. Purpose and Duration: Clear statement of the purpose of the temporary guardianship and its specific duration, including start and end dates
3. Scope of Authority: Detailed description of the medical decision-making powers granted to the temporary guardian
4. Medical Information: Essential medical information about the child including allergies, current medications, and existing medical conditions
5. Emergency Contacts: List of emergency contacts including parents/legal guardians and alternative contacts
6. Consent Declaration: Formal statement of consent by parents/legal guardians authorizing the temporary guardian to make medical decisions
7. Revocation Rights: Statement of the parents'/legal guardians' right to revoke the authorization at any time
8. Execution: Signature section for all parties, including witness signatures and date of execution
1. Insurance Information: Details of medical insurance coverage, to be included if the child has health insurance
2. Special Instructions: Specific instructions for medical care or restrictions, to be included if there are particular medical concerns or preferences
3. Travel Authorization: Permission for interstate or international travel with the child, to be included if travel might be necessary
4. Religious Preferences: Statement of religious beliefs affecting medical treatment, to be included if religious considerations impact medical decisions
5. Custody Information: Details of existing custody arrangements, to be included in cases of divorced or separated parents
1. Schedule A - Medical History: Detailed medical history of the child including past surgeries, hospitalizations, and chronic conditions
2. Schedule B - Vaccination Records: Current vaccination status and schedule of upcoming required vaccinations
3. Schedule C - Medication Schedule: List of current medications with dosage instructions and administration schedule
4. Appendix 1 - Copies of Official Documents: Copies of relevant identification documents, insurance cards, and other official documentation
5. Appendix 2 - Emergency Treatment Protocol: Specific instructions for emergency medical situations and authorized treatments
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Healthcare
Education
Childcare Services
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Youth Organizations
Medical Tourism
International Education
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Healthcare Administration
Child Services
Risk Management
Compliance
Emergency Services
International Relations
Student Affairs
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Relevant Roles
School Administrator
Healthcare Facility Manager
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Child Welfare Officer
Medical Director
School Nurse
Emergency Room Physician
Social Worker
International Student Coordinator
Risk Management Officer
Family Lawyer
Healthcare Compliance Officer
Child Protection Specialist
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