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1. Place and Date: Current location and date of the authorization letter
2. Authorizer's Information: Complete details of the pregnant woman including full legal name, national ID/Iqama number, and contact information
3. Authorized Party Information: Complete details of the person being authorized, including their relationship to the pregnant woman
4. Purpose of Authorization: Clear statement of the purpose - medical care and decisions related to pregnancy
5. Scope of Authorization: Specific medical decisions and actions the authorized person can make or take
6. Duration of Authorization: Time period for which the authorization is valid, typically covering the pregnancy period and immediate postpartum care
7. Declaration of Sound Mind: Statement confirming the pregnant woman is making this authorization willingly and of sound mind
8. Signature Block: Space for signatures of the pregnant woman, authorized person, and witnesses
1. Emergency Contact Information: Additional emergency contacts besides the authorized person, used when multiple backup contacts are desired
2. Medical History Summary: Brief relevant medical history, recommended when there are specific medical conditions that the authorized person should be aware of
3. Specific Restrictions: Any specific decisions or procedures that are explicitly excluded from the authorization scope
4. Religious/Cultural Preferences: Specific religious or cultural preferences regarding medical treatment, included when there are specific religious/cultural considerations
5. Revocation Clause: Specific terms under which the authorization can be revoked, included when the authorizer wants explicit revocation terms
1. Witness Attestation Form: Standard form for witnesses to sign, confirming they witnessed the authorization
2. Hospital Specific Authorization Forms: Any additional forms required by specific healthcare facilities
3. Identity Documents: Copies of identity documents of both the authorizer and authorized person
4. Medical Facility List: List of medical facilities where this authorization is intended to be used
Healthcare
Legal Services
Medical Administration
Insurance
Public Health
Social Services
Legal Affairs
Patient Administration
Medical Records
Obstetrics and Gynecology
Patient Relations
Risk Management
Insurance Coordination
Clinical Operations
Social Services
Medical Director
Hospital Administrator
Legal Counsel
Healthcare Compliance Officer
Patient Relations Manager
Medical Records Officer
Obstetrics Department Head
Gynecologist
Nurse Manager
Insurance Coordinator
Healthcare Risk Manager
Patient Services Coordinator
Medical Social Worker
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