The Permission Medical Authorization Letter is a crucial document in the Philippine healthcare system that addresses the need for delegated medical decision-making authority. This document becomes essential in situations where individuals may be unable to make their own medical decisions, are traveling, or need to authorize others to handle their medical affairs. It must comply with Philippine legislation, including the Universal Health Care Act (RA 11223), Data Privacy Act (RA 10173), and relevant Department of Health regulations. The document typically includes comprehensive details about the grantor, authorized representative, scope of authorization, and specific medical circumstances, while incorporating necessary privacy protections and healthcare provider requirements. It serves as a legal safeguard for all parties involved in medical decision-making and information access.
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1. Date and Location: Current date and place where the letter is executed
2. Healthcare Provider Information: Name and address of the hospital, clinic, or healthcare facility to whom the authorization is directed
3. Grantor Information: Full legal name, address, and contact information of the person giving the authorization
4. Authorized Person Information: Full legal name, address, and contact information of the person being authorized to make medical decisions
5. Patient Information: Full name, date of birth, and relevant identification details of the patient (if different from grantor)
6. Scope of Authorization: Clear statement of what medical decisions or actions are being authorized
7. Duration of Authorization: Specific time period for which the authorization is valid
8. Emergency Contact Details: Alternative contact information for urgent situations
9. Signature Block: Space for grantor's signature, date, and witness signatures
1. Specific Medical Conditions: Details of relevant medical conditions, allergies, or health history when authorization is for specific medical circumstances
2. Insurance Information: Health insurance details when authorization includes handling insurance matters
3. Travel Authorization: Additional provisions when authorization is needed for medical treatment during travel
4. Religious or Cultural Preferences: Specific instructions regarding religious or cultural considerations in medical treatment
5. Revocation Clause: Specific terms under which the authorization can be revoked before the end date
6. Digital Communication Consent: Authorization for receiving medical information through electronic means
1. Medical History Summary: Detailed list of relevant medical history, current medications, and allergies
2. Specific Treatment Instructions: Detailed instructions for specific medical procedures or treatments if applicable
3. Copy of Valid ID: Photocopy of grantor's government-issued identification
4. Proof of Relationship: Documentation proving relationship between grantor and authorized person (if applicable)
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Insurance
Education
Travel and Tourism
Corporate
Legal Services
Government Services
Emergency Services
Senior Care
Child Care
Relevant Teams
Legal
Human Resources
Compliance
Risk Management
Medical Administration
Employee Benefits
Emergency Response
Medical Records
Privacy and Data Protection
Operations
Relevant Roles
Medical Director
Hospital Administrator
Human Resources Manager
School Principal
Legal Counsel
Compliance Officer
Risk Manager
Healthcare Coordinator
Travel Manager
Employee Relations Specialist
Benefits Administrator
Operations Manager
Emergency Services Coordinator
Medical Records Manager
Privacy Officer
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