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1. 1. Identification of Parties: Details of the minor patient, parent/legal guardian granting consent, and the healthcare facility/provider receiving authorization
2. 2. Background: Context explaining the need for advance consent and the circumstances under which it may be used
3. 3. Definitions: Key terms including 'emergency treatment', 'minor', 'authorized representative', 'medical necessity'
4. 4. Scope of Consent: Specific medical treatments and procedures covered by this consent
5. 5. Duration of Authorization: Time period for which the consent remains valid
6. 6. Emergency Contact Information: List of alternative contacts and their order of priority
7. 7. Medical History: Essential medical information including allergies, current medications, and pre-existing conditions
8. 8. Authority of Healthcare Providers: Extent of medical decisions healthcare providers can make under this consent
9. 9. Liability and Indemnification: Legal protections for healthcare providers acting under this consent
10. 10. Signature and Verification: Formal execution section including witness requirements and notarization if required
1. Religious Preferences: Special instructions regarding treatment in accordance with religious beliefs, particularly relevant in Saudi Arabia
2. Transportation Authorization: Permission for medical transport if needed, including ambulance services
3. Photography Consent: Authorization for medical photography if needed for treatment purposes
4. Blood Transfusion Specifications: Specific instructions regarding blood transfusions, which may require separate consent in some cases
5. Alternate Decision Makers: Additional authorized persons who can make decisions in specific circumstances
1. Schedule A - Medical History Form: Detailed medical history questionnaire including allergies, medications, and previous surgeries
2. Schedule B - Emergency Contact List: Comprehensive list of emergency contacts with full contact details and relationship to minor
3. Schedule C - Authorized Treatments: Specific list of pre-approved medical treatments and procedures
4. Appendix 1 - Identity Documents: Copies of relevant identity documents for minor and parent/guardian
5. Appendix 2 - Healthcare Facility Information: List of approved healthcare facilities covered by this consent
Healthcare
Medical Services
Pediatric Care
Emergency Services
Medical Insurance
Legal Services
Education (School Health Services)
Sports and Recreation (Medical Support)
Youth Services
Legal
Compliance
Risk Management
Patient Services
Emergency Medicine
Pediatrics
Medical Records
Insurance Coordination
Clinical Operations
Administrative Services
Medical Director
Hospital Administrator
Pediatrician
Emergency Room Physician
School Nurse
Healthcare Compliance Officer
Legal Counsel
Risk Management Officer
Patient Services Coordinator
Medical Records Manager
Insurance Coordinator
Clinical Services Manager
Healthcare Facility Manager
Pediatric Department Head
Emergency Services Director
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