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1. Patient Information: Essential identifying details of the patient including full name, IC/passport number, age, gender, and contact information
2. Emergency Contact Details: Information about next of kin or legal guardian who can be contacted in emergency situations
3. Medical Condition Summary: Brief description of the current medical emergency or condition requiring immediate attention
4. Proposed Emergency Treatment/Procedure: Clear description of the immediate medical intervention being proposed
5. Risks and Benefits: Brief outline of major risks and expected benefits of the emergency procedure
6. Consent Declaration: Clear statement of consent for the emergency treatment, including acknowledgment of risks
7. Authorization Signature: Space for patient/guardian signature, date, and time of consent
1. Interpreter Declaration: Required when consent is obtained through an interpreter for non-English/Malay speaking patients
2. Mental Capacity Assessment: Required when there are concerns about the patient's capacity to provide informed consent
3. Religious/Cultural Considerations: Required when specific religious or cultural factors affect treatment decisions
4. Alternative Treatment Options: Can be included when time permits and alternatives exist, though may not be practical in extreme emergencies
5. Witness Section: Additional witness signatures section for high-risk procedures or when patient is unable to sign
6. Photography/Recording Consent: Required when the emergency procedure may need photographic or video documentation
1. Medical Procedure Description: Detailed technical description of the emergency procedure (attached as reference)
2. Patient Rights Summary: Summary of patient rights in emergency situations as per Malaysian healthcare laws
3. Hospital Policy Reference: Relevant hospital policies regarding emergency procedures and consent
4. Advance Directive Form: If available, to be attached for reference in relation to pre-existing medical decisions
Healthcare
Medical Services
Emergency Services
Hospital Administration
Ambulatory Care
Urgent Care
Medical Tourism
Healthcare Education
Medical Insurance
Emergency Medicine
Legal & Compliance
Risk Management
Quality Assurance
Medical Records
Patient Services
Clinical Operations
Hospital Administration
Medical Affairs
Patient Safety
Emergency Room Physician
Hospital Administrator
Medical Director
Nurse Manager
Legal Compliance Officer
Risk Management Officer
Quality Assurance Manager
Medical Records Officer
Emergency Department Coordinator
Patient Services Manager
Healthcare Facility Manager
Clinical Operations Director
Medical Legal Advisor
Emergency Medicine Consultant
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