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1. Patient Information: Complete identification details of the patient including full name, Qatar ID number, date of birth, and contact information

2. Authorizing Party Details: Full details of the person giving authorization, including their relationship to the patient if not self-authorizing

3. Authorized Healthcare Provider: Details of the healthcare provider(s) or facility authorized to provide treatment

4. Scope of Authorization: Specific medical procedures, treatments, or decisions being authorized

5. Duration of Authorization: Clear statement of the time period for which the authorization is valid

6. Declaration and Signature: Formal declaration of understanding and consent, with space for signature and date

1. Identity Verification Documents: Copies of Qatar ID, passport, or other official identification documents of both patient and authorizing party

2. Proof of Relationship: Legal documents proving the relationship between patient and authorizing party (if applicable), such as birth certificate or power of attorney

3. Medical History Summary: Brief summary of relevant medical history, if pertinent to the authorization

4. Witness Declaration: Additional form for witness signatures, particularly important for major medical decisions