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1. Patient Information (Patienteninformation): Full legal name, date of birth, address, insurance number, and contact details of the patient
2. Healthcare Provider Information (Gesundheitsdienstleister Information): Details of the medical facility, treating physician(s), or healthcare providers being authorized
3. Scope of Authorization (Umfang der Vollmacht): Detailed description of the medical decisions and actions being authorized, including treatment types and medical information access
4. Duration of Authority (Dauer der Vollmacht): Specification of the time period for which the authorization is valid, including start date and expiration conditions
5. Data Protection Declaration (Datenschutzerklärung): GDPR-compliant section describing how medical data will be handled, processed, and protected
6. Revocation Rights (Widerrufsrecht): Information about the patient's right to revoke the authorization and the process for doing so
7. Signatures (Unterschriften): Signature blocks for patient, witnesses, and/or notary as required
1. Authorized Representative (Bevollmächtigter Vertreter): Section for designating a third party to make medical decisions, used when the patient wants to authorize someone else to act on their behalf
2. Emergency Contact Information (Notfallkontakte): Additional contacts to be notified in medical emergencies, included when patient wants specific individuals informed
3. Specific Treatment Exclusions (Spezifische Behandlungsausschlüsse): List of treatments or procedures specifically not authorized, used when patient wants to exclude certain medical interventions
4. Language Preference (Sprachpräferenz): Specification of preferred language for medical communication, included in multilingual settings or for non-German speaking patients
1. List of Authorized Healthcare Providers: Detailed list of specific healthcare providers, departments, or facilities covered by the authorization
2. Specific Medical Procedures Authorization: Detailed list of specific medical procedures or treatments being authorized, with any specific conditions or limitations
3. Data Processing Consent Form: Detailed GDPR-compliant consent form for specific types of data processing and sharing
Healthcare
Medical Services
Hospital Administration
Elder Care
Mental Health Services
Rehabilitation Services
Insurance
Legal Services
Healthcare Technology
Pharmaceutical
Legal
Compliance
Medical Administration
Patient Services
Records Management
Risk Management
Quality Assurance
Data Protection
Clinical Operations
Patient Care
Medical Director
Hospital Administrator
Physician
Nurse Practitioner
Legal Counsel
Compliance Officer
Data Protection Officer
Healthcare Facility Manager
Patient Rights Advocate
Medical Records Manager
Healthcare Documentation Specialist
Risk Management Officer
Quality Assurance Manager
Medical Office Administrator
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