The Emergency Medical Permission Form is a critical document used in the Philippines when immediate medical attention may be required but direct consent from the patient might not be possible. This document, governed by Philippine healthcare laws including the Universal Health Care Act (RA 11223) and the Medical Act of 1959 (RA 2382), serves as pre-authorized consent for medical treatment in emergency situations. It is particularly important for individuals with known medical conditions, minors in school or activities, employees in high-risk occupations, and travelers. The form includes comprehensive patient information, medical history, treatment authorizations, and emergency contact details, while incorporating necessary provisions for data privacy under RA 10173. It provides legal protection for both healthcare providers and patients, ensuring prompt medical intervention when needed while respecting patient rights and preferences.
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1. Patient Information: Complete identification details of the patient including full name, date of birth, address, and contact information
2. Emergency Contacts: List of primary and secondary emergency contacts with their relationship to the patient and contact details
3. Medical Authorization: Clear statement granting permission for emergency medical treatment and procedures
4. Scope of Permission: Specific details about what medical interventions are authorized and under what circumstances
5. Financial Responsibility: Statement regarding who will be responsible for medical expenses incurred
6. Release of Liability: Clause protecting healthcare providers from liability when acting in good faith under this permission
7. Duration and Validity: Period for which the permission remains valid and circumstances under which it expires
8. Signatures: Space for signatures of the grantor, witnesses, and date of execution
1. Minor Patient Authorization: Additional section required when the patient is under 18, including parental/guardian details and specific permissions
2. Special Medical Conditions: Section detailing any existing medical conditions, allergies, or specific medical needs that emergency responders should be aware of
3. Religious or Cultural Preferences: Special instructions regarding treatment preferences based on religious or cultural beliefs
4. Organ Donation Authorization: Optional permission for organ donation in case of death
5. Language Preference: Preferred language for communication and need for interpreter services
6. Insurance Information: Details of health insurance coverage and policy information
1. Medical History Form: Detailed form listing patient's medical history, previous surgeries, and ongoing medications
2. List of Authorized Medical Procedures: Specific medical procedures pre-authorized for emergency situations
3. Insurance Documentation: Copies of insurance cards and relevant policy information
4. Identification Documents: Copies of valid government ID and other relevant identification documents
5. Special Instructions: Any specific medical instructions, care preferences, or restrictions that need to be considered
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Healthcare
Insurance
Education
Sports and Recreation
Tourism and Hospitality
Manufacturing
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Transportation
Events and Entertainment
Child Care Services
Relevant Teams
Human Resources
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Risk Management
Compliance
Health and Safety
Operations
Administrative Services
Medical Services
Student Affairs
Employee Relations
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Human Resources Manager
School Administrator
Medical Facility Administrator
Risk Management Officer
Compliance Officer
Health and Safety Coordinator
School Nurse
Company Doctor
Athletic Director
Tour Operator
Event Manager
Construction Site Manager
Workplace Safety Officer
Employee Relations Manager
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