The Medical Treatment Release Form is a critical document required in Indonesian healthcare settings before performing medical procedures or treatments. It serves as both a legal protection mechanism and an important communication tool between healthcare providers and patients. The document is designed to comply with Indonesian healthcare regulations, particularly Law No. 36 of 2009 on Health and related ministerial regulations. This form should be used prior to any significant medical procedure, documenting informed consent, acknowledging understanding of risks and benefits, and releasing the healthcare provider from liability for known complications. It includes detailed information about the proposed treatment, alternatives, risks, and financial responsibilities, while ensuring alignment with Indonesian legal requirements for medical documentation and patient rights protection.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Genie AI's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Patient Information: Complete identification details of the patient including full name, ID number (KTP/passport), date of birth, address, and contact information
2. Healthcare Provider Information: Details of the hospital/clinic, treating physician(s), and relevant medical staff involved in the treatment
3. Medical Condition and Proposed Treatment: Description of the current medical condition and the proposed medical treatment or procedure
4. Risks and Benefits: Detailed explanation of potential risks, complications, and expected benefits of the proposed treatment
5. Alternative Treatments: Information about alternative treatment options and consequences of refusing treatment
6. Consent Declaration: Express statement of consent for the treatment, acknowledging understanding of risks and benefits
7. Financial Responsibility: Statement regarding payment obligations and insurance coverage
8. Release of Liability: Clause releasing the healthcare provider from liability for known risks and complications
9. Emergency Authorization: Permission for emergency procedures if deemed necessary during treatment
10. Signatures and Witnesses: Space for signatures of patient/guardian, healthcare provider, and witnesses with date
1. Interpreter Declaration: Required when the patient needs language interpretation services, including interpreter's certification of accurate translation
2. Guardian/Representative Authorization: Needed when the patient is a minor or legally incapable of providing consent
3. Blood Products Consent: Specific section for procedures that may require blood transfusions or blood products
4. Photography/Recording Consent: Permission for medical photography or recording for documentation or educational purposes
5. Research Participation: Optional consent for use of medical data in research or educational contexts
6. Religious/Cultural Considerations: Special instructions or restrictions based on religious or cultural beliefs
7. Organ/Tissue Donation: Optional consent for organ or tissue donation in relevant cases
1. Detailed Medical Procedure Description: Technical description of the medical procedure with diagrams or illustrations
2. Pre-procedure Instructions: Detailed instructions for preparation before the medical procedure
3. Post-procedure Care Instructions: Detailed instructions for post-procedure care and recovery
4. Medicine Schedule: List of medications, dosages, and administration schedule if applicable
5. Emergency Contact Information: List of emergency contacts and relevant medical staff contact information
6. Cost Breakdown: Detailed breakdown of expected costs and payment terms if applicable
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Hospital Administration
Insurance
Legal Services
Healthcare Education
Medical Research
Pharmaceutical
Emergency Services
Relevant Teams
Legal
Compliance
Medical Administration
Patient Relations
Risk Management
Quality Assurance
Medical Records
Clinical Operations
Emergency Services
Insurance Coordination
Administrative Services
Relevant Roles
Medical Director
Hospital Administrator
Chief Medical Officer
Legal Counsel
Compliance Officer
Risk Manager
Patient Relations Manager
Medical Records Manager
Nursing Director
Quality Assurance Manager
Healthcare Operations Manager
Clinical Services Director
Admissions Manager
Emergency Department Director
Insurance Coordinator
Find the exact document you need
Title And Lien Release
An Indonesian law-governed document that releases security interests over property and confirms clear title transfer, subject to local property and security regulations.
find out more
Medical Work Release Form
An Indonesian-compliant document that certifies an employee's medical fitness to return to work, including any necessary workplace accommodations or restrictions.
find out more
Online Release Form
An Indonesian law-compliant electronic release form for obtaining digital consents and liability waivers.
find out more
Authorization To Release Employee Information Form
Indonesian-compliant authorization form for releasing employee information to third parties, aligned with PDP Law requirements.
find out more
Motor Vehicle Record Disclosure And Release Form
An Indonesian legal form authorizing the release of motor vehicle records in compliance with local transportation and privacy laws.
find out more
Consent Form For Release Of Information
An Indonesian law-compliant consent form for authorizing the collection, processing, and sharing of personal information under the PDP Law.
find out more
Tenant Release Form
An Indonesian law-compliant document that formally terminates a lease agreement and releases both landlord and tenant from future rental obligations.
find out more
Patient Release Form
An Indonesian healthcare document that formally records a patient's discharge from medical care, including discharge instructions and legal acknowledgments, in compliance with Indonesian healthcare regulations.
find out more
Promissory Note Release
An Indonesian law-governed document that formally releases and discharges obligations under a promissory note, providing legal evidence of debt satisfaction.
find out more
Minor Release Form
An Indonesian law-compliant document providing parental/guardian authorization for a minor's participation in activities and use of their likeness.
find out more
Medical Photo Consent Form
An Indonesian-compliant consent form for medical photography that documents patient authorization and usage rights while ensuring privacy protection under Indonesian law.
find out more
Audio Release Form
An Indonesian law-compliant agreement authorizing the use, reproduction, and distribution of audio recordings, protecting both content creators and users.
find out more
Medical Treatment Authorization And Consent Form
An Indonesian-compliant medical consent form authorizing healthcare providers to perform specified medical treatments while documenting informed patient consent.
find out more
Release Of Information Form Mental Health
An Indonesian-compliant authorization form for the release of confidential mental health information, following local healthcare and data protection regulations.
find out more
Revocation Of Authorization To Disclose Health Information
An Indonesian legal document for revoking previous authorization to disclose health information, complying with national health privacy and data protection laws.
find out more
Participant Release Form
An Indonesian law-governed release form establishing participation terms, consent, and liability waivers for events and activities.
find out more
Customer Release Form
An Indonesian-law governed release form documenting customer acknowledgment and acceptance of activity/service risks, drafted in compliance with local consumer protection laws.
find out more
Landlord Release Form
An Indonesian law-compliant document that mutually releases landlord and tenant from their lease obligations and settles all related matters.
find out more
Medical Treatment Release Form
An Indonesian-compliant medical consent form that documents patient approval for treatment and releases healthcare providers from liability for known risks.
find out more
Termination Of Account Letter
An Indonesian-compliant formal notice confirming the termination of a banking account relationship, including closure details and required actions.
find out more
Gym Disclaimer Form
An Indonesian-law compliant disclaimer form for gym facilities that establishes usage terms and liability waivers while protecting both facility and user interests.
find out more
Release Of Information
An Indonesian law-compliant document authorizing the controlled release of specific information between parties, subject to PDP Law requirements.
find out more
Photography Consent Form
An Indonesian-compliant consent form for photography usage and rights, addressing data protection and privacy requirements under Indonesian law.
find out more
Release Of Liability
An Indonesian law-compliant document where one party waives their right to make legal claims against another party for specified potential damages or losses.
find out more
Authorization To Release Confidential Information
An Indonesian law-compliant authorization document for the controlled release of confidential information, adhering to PDP Law requirements.
find out more
Patient Information Release Form
An Indonesian-compliant authorization form for the release of patient medical information, meeting local healthcare privacy and data protection requirements.
find out more
Participation Waiver Form
An Indonesian law-governed waiver form where participants acknowledge risks and release the organization from liability for specified activities.
find out more
Babysitter Medical Consent Form
An Indonesian law-compliant authorization form enabling babysitters to make medical decisions for minors in their care.
find out more
Consent To Share Information
An Indonesian law-compliant consent document for authorized information sharing, aligned with the PDP Law requirements.
find out more
Release Request Form
An Indonesian-compliant formal document used to request the release of information, documents, or assets, including necessary declarations and commitments from the requesting party.
find out more
Personal Release And Consent Form
An Indonesian law-compliant Personal Release and Consent Form for obtaining and documenting authorized consent for personal data use and content release.
find out more
New Release Form
An Indonesian law-governed release form documenting the formal waiver of rights, claims, or liabilities between parties, compliant with the Indonesian Civil Code.
find out more
Injury Release Form
An Indonesian law-compliant waiver document protecting organizations from liability claims related to voluntary participation in potentially risky activities.
find out more
Employee Key Release Form
An Indonesian-compliant form documenting the issuance of company keys/access devices to employees and their associated responsibilities.
find out more
Temporary Guardian Medical Release Form
An Indonesian legal document authorizing a temporary guardian to make medical decisions for a minor child when parents/legal guardians are unavailable.
find out more
Physical Therapy Release Form
An Indonesian-compliant legal document establishing consent, terms, and conditions for physical therapy services while protecting both healthcare provider and patient interests.
find out more
Medical Release Form To Return To Work
An Indonesian-compliant medical clearance form authorizing an employee's return to work after medical leave, including necessary work modifications and healthcare provider certification.
find out more
Hospital Release Form
An Indonesian-compliant document formalizing a patient's discharge from hospital care, including medical instructions and administrative clearance.
find out more
Driving Record Consent Form
An Indonesian-compliant consent form for accessing and reviewing individual driving records, adhering to local data protection and transportation laws.
find out more
Background Release Form
An Indonesian law-compliant authorization form for conducting background checks on individuals, incorporating PDP Law requirements and consent mechanisms.
find out more
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)