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Letter Of Consent Medical Authorisation Form
"I need a Letter of Consent Medical Authorisation Form for my hospital's cardiology department that covers both routine procedures and emergency interventions, with specific provisions for data sharing with our research partners."
1. Patient Information: Personal details including full name, date of birth, NHS number, contact details and address
2. Healthcare Provider Details: Information about the medical facility, department, and responsible healthcare professional
3. Scope of Authorization: Detailed description of specific medical procedures, treatments, or information access being authorized
4. Duration of Authorization: Specific time period or conditions for which the authorization remains valid
5. Data Protection Statement: Information about how personal data will be processed, stored, and shared in accordance with GDPR
6. Declaration and Signature: Formal statement of consent, understanding, and voluntary agreement, including signature blocks and date
1. Emergency Contact Authorization: Additional section for naming alternative decision-makers or emergency contacts
2. Interpreter Declaration: Section to be completed when consent discussions are conducted through an interpreter
3. Clinical Photography Consent: Optional authorization for medical photography or imaging
4. Special Instructions: Any specific requirements or conditions related to the authorization
5. Withdrawal of Consent: Information about how to withdraw consent and the process involved
1. Procedure Information Sheet: Detailed information about specific medical procedures or treatments being authorized
2. Risk Disclosure Form: Comprehensive documentation of risks discussed and acknowledged
3. Capacity Assessment Form: Documentation of mental capacity assessment if required
4. Privacy Notice: Detailed information about data protection rights and processing activities
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