Temporary Medical Permission Form Template for England and Wales

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Key Requirements PROMPT example:

Temporary Medical Permission Form

"I need a Temporary Medical Permission Form for my 16-year-old daughter to receive ongoing physiotherapy treatment at London Bridge Hospital from January to June 2025, including provisions for emergency treatment if needed."

Document background

The Temporary Medical Permission Form serves as a critical document in healthcare settings across England and Wales, enabling medical professionals to obtain necessary consent for specific treatments or procedures within a defined timeframe. This document is particularly important when immediate or ongoing medical care is required but permanent authorization isn't necessary or appropriate. It includes detailed patient information, scope of permitted procedures, duration of authorization, and relevant medical history, while ensuring compliance with the Mental Capacity Act 2005 and Data Protection Act 2018.

Suggested Sections

1. Patient Information: Full legal name, date of birth, address, NHS number and other identifying details of the patient

2. Guardian/Parent Information: Details of person giving permission including full name, relationship to patient, contact information and authority to consent

3. Medical Provider Information: Details of healthcare provider or facility including name, registration numbers, and contact information

4. Scope of Permission: Detailed description of specific medical treatments or procedures covered by this permission

5. Duration: Specific time period for which the permission is valid, including start and end dates

6. Declaration: Formal confirmation of understanding and consent, including signature requirements and witness details

Optional Sections

1. Emergency Contact Details: Additional contacts in case of emergency, typically used for longer-term permissions or high-risk procedures

2. Medical History: Relevant medical background information when past medical history may impact treatment

3. Specific Restrictions: Any limitations or exclusions on the permission granted, including specific procedures that are not authorized

Suggested Schedules

1. Schedule 1: Medical Procedures: Detailed list of specific procedures covered by this permission

2. Schedule 2: Information Sharing: List of authorized parties for information sharing and communication protocols

3. Appendix A: Patient Rights: Summary of patient rights and procedures for withdrawing consent

4. Appendix B: Emergency Protocols: Procedures and protocols for emergency situations where standard permission process may be bypassed

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

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Education
Sports and Recreation
Emergency Services

Relevant Teams

Medical Administration
Legal
Compliance
Patient Services
Records Management

Relevant Roles

Medical Director
General Practitioner
Nurse Practitioner
Healthcare Administrator
Compliance Officer

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Let's create your Temporary Medical Permission Form

Authors

Alex Denne

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