Emergency Medical Permission Form Template for England and Wales

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Key Requirements PROMPT example:

Emergency Medical Permission Form

"I need an Emergency Medical Permission Form for my 14-year-old daughter who will be attending a three-month student exchange program in London from January 2025, with specific provisions for her severe nut allergy and asthma medication requirements."

Document background

The Emergency Medical Permission Form serves as a critical legal instrument in England and Wales, enabling healthcare providers to deliver urgent medical care when immediate consent cannot be obtained. This document becomes particularly important in situations involving unconscious patients, minors, or individuals temporarily unable to make medical decisions. The form typically includes the grantor's personal information, medical history, emergency contacts, and specific treatment preferences or restrictions. It must comply with various legislation including the Mental Capacity Act 2005, Data Protection Act 2018, and relevant NHS regulations.

Suggested Sections

1. Personal Information: Patient's full name, date of birth, address, NHS number, and contact details

2. Emergency Contacts: Names, relationships, and contact information for primary and secondary emergency contacts with authority to make decisions

3. Medical History: Current medical conditions, allergies, medications, and relevant medical history

4. Consent Declaration: Express permission for emergency medical treatment and acknowledgment of risks

5. Liability and Indemnification: Statements regarding liability limitations and indemnification of healthcare providers

6. Data Protection Notice: Information about how medical data will be processed, stored, and shared in emergencies

7. Signature Block: Date, signature lines for grantor, witnesses, and healthcare provider acknowledgment

Optional Sections

1. Religious or Cultural Preferences: Specific religious or cultural requirements regarding medical treatment and care

2. Specific Treatment Exclusions: List of treatments or procedures specifically declined by the patient

3. Insurance Information: Health insurance details, policy numbers, and coverage information

4. Capacity Assessment: Section addressing mental capacity assessment where relevant under Mental Capacity Act 2005

5. Additional Medical Instructions: Specific medical instructions or preferences not covered in main sections

Suggested Schedules

1. Schedule A - Medical History Form: Detailed questionnaire covering patient's complete medical history

2. Schedule B - Identification Documents: Copies of required identification documents and proof of address

3. Schedule C - Existing Medical Records: Relevant past medical records or treatment history

4. Schedule D - Emergency Contact Verification: Documentation verifying authority of emergency contacts to make decisions

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Let's create your Emergency Medical Permission Form

Authors

Alex Denne

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