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1. Patient Information: Complete identification details of the patient including full name, IC/passport number, date of birth, and contact information
2. Emergency Contacts: Names and contact information of primary and secondary emergency contacts with their relationship to the patient
3. Medical History Summary: Brief overview of relevant medical conditions, allergies, and current medications that emergency personnel should be aware of
4. Consent Declaration: Clear statement of consent for emergency medical treatment, including authorization for necessary procedures and interventions
5. Scope of Authorization: Specific details about what medical procedures and treatments are being authorized in emergency situations
6. Financial Responsibility: Statement regarding responsibility for medical expenses incurred during emergency treatment
7. Duration and Validity: Period for which the consent remains valid and conditions for renewal or termination
8. Signatures and Witnessing: Space for signatures of the patient or legal guardian, witnesses, and date of signing
1. Religious or Cultural Preferences: Specific religious or cultural considerations that should be respected during emergency treatment
2. Organ Donation Preferences: Patient's wishes regarding organ donation in case of fatal emergencies
3. Special Instructions for Minors: Additional provisions when the patient is a minor, including parental consent requirements
4. Mental Health Considerations: Special provisions for patients with mental health conditions that may affect decision-making capacity
5. Advanced Directives Reference: Reference to any existing advanced directives or living will documents
6. Language Assistance Requirements: Specifications for language interpretation needs in emergency situations
1. Schedule A: Detailed Medical History: Comprehensive medical history including past surgeries, chronic conditions, and family history
2. Schedule B: Current Medication List: Detailed list of current medications, dosages, and prescribing physicians
3. Schedule C: Insurance Information: Details of medical insurance coverage, policy numbers, and contact information
4. Appendix 1: Emergency Treatment Facility List: List of preferred or nearby emergency treatment facilities and their contact information
5. Appendix 2: Medical Power of Attorney: Copy of any existing Medical Power of Attorney documentation
Healthcare
Education
Sports and Recreation
Manufacturing
Construction
Mining
Oil and Gas
Transportation
Hospitality
Corporate Services
Legal
Compliance
Human Resources
Health and Safety
Risk Management
Emergency Response
Medical Services
Administrative Services
Operations
Medical Director
Hospital Administrator
Legal Counsel
Compliance Officer
Risk Manager
Human Resources Manager
Occupational Health Manager
Safety Officer
School Principal
Sports Facility Manager
Corporate Secretary
Employee Relations Manager
Health and Safety Coordinator
Emergency Response Coordinator
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