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1. Parties: Identification of the patient, primary caregiver, and any backup caregivers, including full legal names, contact information, and relationships
2. Background: Brief context about the caregiving arrangement and reason for the medical permission form
3. Definitions: Clear definitions of key terms used in the document, including 'medical emergency', 'routine care', 'authorized medical decisions', etc.
4. Scope of Authority: Detailed outline of what medical decisions and actions the caregiver is authorized to make or take
5. Duration of Authority: Specification of how long the medical permission remains valid and conditions for renewal
6. Emergency Procedures: Specific protocols and authorizations for emergency medical situations
7. Medical Information Access: Authorization for the caregiver to access medical records and receive medical information
8. Healthcare Provider Communication: Authorization for direct communication between caregiver and healthcare providers
9. Limitations and Restrictions: Clear statement of what decisions or actions are NOT authorized
10. Revocation Clause: Process and conditions for revoking or modifying the medical permission
11. Signatures and Attestation: Space for formal execution of the document by all parties
1. Special Medical Conditions: Additional provisions for specific medical conditions requiring specialized care or treatment protocols
2. International Travel Authorization: Special permissions for medical care during international travel, if applicable
3. Alternative Decision Makers: Hierarchy of decision-making authority when primary caregiver is unavailable
4. Religious or Cultural Preferences: Specific instructions regarding medical care based on religious or cultural beliefs
5. Insurance Information: Authorization for caregiver to communicate with insurance providers and handle claims
6. Temporary Transfer of Authority: Provisions for temporarily transferring medical decision-making authority to another person
1. Schedule A - Medical History: Detailed medical history of the patient including allergies, medications, and chronic conditions
2. Schedule B - Emergency Contacts: Comprehensive list of emergency contacts including backup caregivers and family members
3. Schedule C - Preferred Healthcare Providers: List of patient's regular doctors, specialists, and preferred healthcare facilities
4. Schedule D - Medication Schedule: Current medications, dosages, and administration schedule
5. Appendix 1 - Medical Privacy Waiver: Detailed HIPAA-equivalent privacy waiver for Philippine healthcare context
6. Appendix 2 - Specific Treatments Authorization: Detailed list of specific treatments or procedures the caregiver is authorized to approve
Healthcare
Elder Care
Social Services
Insurance
Legal Services
Home Healthcare
Medical Facilities
Nursing Homes
Rehabilitation Centers
Disability Services
Mental Health Services
Legal
Compliance
Patient Care
Medical Records
Risk Management
Healthcare Administration
Insurance Coordination
Social Services
Quality Assurance
Patient Relations
Caregiver
Home Health Aide
Registered Nurse
Licensed Practical Nurse
Healthcare Administrator
Medical Director
Social Worker
Case Manager
Healthcare Facility Manager
Patient Care Coordinator
Legal Compliance Officer
Insurance Coordinator
Medical Records Manager
Healthcare Attorney
Patient Relations Manager
Risk Management Officer
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