The Medical Release Form For Minor is a critical document used in Belgian healthcare and educational settings when parents or legal guardians need to pre-authorize medical treatment for their minor children. This document becomes essential in situations where immediate parental consent might not be possible, such as during school hours, sports activities, or emergency situations. The form must comply with Belgian healthcare laws, including the Law on Patient Rights (2002) and the Belgian Civil Code provisions regarding parental authority, as well as EU GDPR requirements for handling medical data. It typically includes comprehensive information about the child's medical history, emergency contacts, and specific treatment authorizations, while clearly defining the scope of medical decisions that can be made in the parents' absence.
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1. Child Information: Full legal name, date of birth, address, and relevant identification numbers of the minor
2. Parent/Guardian Information: Full details of parent(s)/legal guardian(s) including contact information and relationship to child
3. Medical Care Authorization: Scope of medical treatment authorization, including routine, emergency, and surgical care
4. Healthcare Provider Rights: Authorization for healthcare providers to perform necessary examinations, treatments, and procedures
5. Medical Information Release: Authorization to release relevant medical information to treating healthcare providers
6. Emergency Contact Details: Alternative contacts if parent/guardian cannot be reached
7. Duration and Validity: Time period for which the authorization is valid
8. Declarations and Acknowledgments: Statements confirming understanding and agreement to terms
9. Signature Block: Formal execution section including date, witness requirements, and notarization if required
1. Specific Treatment Exclusions: Section to list any specific treatments or procedures that are explicitly not authorized
2. Religious or Cultural Preferences: Specific religious or cultural considerations that should be respected in medical treatment
3. Insurance Information: Details of medical insurance coverage and billing preferences
4. Medical History: Brief medical history including allergies, current medications, and existing conditions
5. Travel Authorization: Additional authorization for medical treatment during travel or school trips
6. Custody Information: Required when parents are separated/divorced or in cases of complex guardianship arrangements
1. Schedule A - Medical History Form: Detailed form for recording the child's medical history, allergies, and current medications
2. Schedule B - Emergency Contact List: Comprehensive list of emergency contacts with detailed contact information and relationship to child
3. Schedule C - Specific Authorizations: Detailed list of specific procedures or treatments being authorized or excluded
4. Appendix 1 - Privacy Notice: Required GDPR-compliant privacy notice explaining how medical information will be processed and protected
5. Appendix 2 - Hospital Preferences: List of preferred hospitals or medical facilities where treatment should be sought if possible
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