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1. Patient Information: Complete details of the person receiving care, including full name, IC number/passport, date of birth, and contact information
2. Caregiver Information: Details of the primary caregiver including full name, IC number/passport, relationship to patient, and contact information
3. Emergency Contacts: List of alternative contacts in order of priority, including their relationship to the patient and contact details
4. Medical Authorization Scope: Specific medical decisions and actions the caregiver is authorized to make or take on behalf of the patient
5. Healthcare Provider Authorization: Permission for healthcare providers to share medical information with and accept instructions from the caregiver
6. Duration of Authorization: Timeframe for which the permission is valid, including start date and expiration date if applicable
7. Revocation Terms: Conditions and process for revoking or modifying the permissions granted
8. Declaration and Signatures: Formal statements of understanding and agreement, with spaces for signatures of all relevant parties
1. Mental Health Provisions: Additional authorizations specific to mental health treatment and decisions, required when the patient has mental health conditions
2. Religious/Cultural Preferences: Specific religious or cultural considerations that should guide medical care, included when religious or cultural factors affect medical decisions
3. International Travel Authorization: Permission for medical care during international travel, needed when the patient may require care outside Malaysia
4. Specific Treatment Restrictions: Any specific treatments or procedures that are explicitly not authorized, included when there are specific medical procedures the patient wishes to exclude
5. Alternative Caregiver Designation: Authorization for backup caregivers, included when multiple caregivers may be involved in patient care
1. Schedule A: Medical History: Detailed medical history including current conditions, medications, allergies, and previous surgeries
2. Schedule B: Treatment Preferences: Specific preferences for various types of medical treatments and interventions
3. Schedule C: Emergency Protocols: Step-by-step procedures for various emergency scenarios
4. Appendix 1: Healthcare Provider List: List of current healthcare providers, specialists, and their contact information
5. Appendix 2: Insurance Information: Details of medical insurance coverage and relevant policy information
6. Appendix 3: Medication Schedule: Current medication list with dosages, timing, and special instructions
Healthcare
Elder Care
Social Services
Medical Insurance
Disability Services
Home Healthcare
Rehabilitation Services
Mental Health Services
Palliative Care
Residential Care
Legal
Compliance
Patient Services
Medical Records
Risk Management
Care Coordination
Insurance Processing
Social Services
Quality Assurance
Healthcare Administration
Healthcare Administrator
Medical Director
Nursing Manager
Social Worker
Care Coordinator
Legal Compliance Officer
Patient Services Manager
Healthcare Risk Manager
Medical Records Officer
Insurance Claims Specialist
Elder Care Specialist
Disability Support Coordinator
Home Care Manager
Palliative Care Coordinator
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