hospital power of attorney
When the power of attorney entrusts others to exercise their legitimate rights and interests on their own behalf, the client shall not go back on the entrusted matters for any reason. In daily life and work, the scope of application of power of attorney is more and more extensive, so how to write a good power of attorney? The following is the hospital power of attorney I compiled for you, welcome to share.
power of attorney for the hospital 1
Because the patient is seriously ill at work, he has traveled far abroad.
I really can't apply for medical records in person, so I hereby entrust you to apply to your hospital on your behalf. The scope of the application materials is:
for your use.
To this hospital
Client: (signature) ID number:
Household registration address:
Consignee: ID number:
Household registration address:
Tel:
Year, month, day,
Photocopy of the client's certificate
Photocopy of the trustee's certificate 2
According to this hospital's power of attorney. Chapter 7, Article 56 of the Tort Liability Law of the People's Republic of China states that "if the opinions of patients or their close relatives cannot be obtained due to emergency situations such as rescuing dying patients, corresponding medical measures can be implemented immediately with the approval of the person in charge of the medical institution or the authorized person in charge", and Article 1 of the Basic Code for Medical Record Writing "………………………………………………………………………………………………………………………………………………………………………………………………………………………
gender: female;
Nationality: Han nationality
Position: hospital president, legal representative
Trustee:
1. Vice-president of business and cadre of medical department
2. General duty of hospital
Authorized matters:
In emergency situations such as saving dying patients, if the opinions of patients or their close relatives cannot be obtained, the trustee shall execute the opinions of the person in charge of medical institutions.
authorization period: long term.
client:
____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ During my stay in the hospital, I solemnly entrust you as my agent to exercise the right of informed consent during my stay in the hospital, and perform the corresponding signing procedures. The signature of the authorized representative is deemed as my signature.
the patient shall bear the consequences after the client signs the consent form.
patient's signature: (or fingerprint) 2xx, xx, xx, xx, xx minutes
trustee's signature: (or fingerprint) 2xx, xx, xx, xx minutes
physician's signature:
talking place: xx, xx, xx, xx minutes, xx hospital's power of attorney article 4
according to "Chinese People's * * * Article 56 of Chapter VII of the Tort Liability Law of the People's Republic of China states that "if the opinions of patients or their close relatives cannot be obtained due to emergency situations such as rescuing dying patients, the corresponding medical measures can be implemented immediately with the approval of the person in charge of the medical institution or the authorized person in charge", and Article 1 of the Basic Code for Writing Medical Records states that "…………………………………………………………………………………………………………………………………………………………………………………………………………………… Gender: female; Nationality: Han nationality Position: hospital president, legal representative
Trustee:
1. Vice president of business, medical department cadre
2. General duty of the hospital
Authorized matters:
In case of emergency such as saving dying patients, if the opinions of the patients or their close relatives cannot be obtained, the trustee shall execute the approval right of the person in charge of the medical institution to immediately implement corresponding medical measures for the patients.
authorization period: long term.
client: year, month and day
Attachment: list of trustees:
xxx, xxx, power of attorney for xxx hospital 5
Patient's name:
Gender:
Age:
Medical record number:
Client (patient himself). : gender and age
valid ID number: address:
Trustee: gender and age Tel:
valid ID number: address:
Relationship with patients: □ spouse □ children □ parents □ other close relatives □ colleagues □ friends □ others
I was hospitalized due to illness on. During my stay in the hospital, I solemnly entrust you as my agent to exercise the right of informed consent during my stay in the hospital, and perform the corresponding signing procedures. The signature of the principal is deemed as my signature.
the patient shall bear the consequences after the client signs the consent form.
patient's signature: (handprint) year month day
trustee's signature: (handprint) year month day hospital power of attorney chapter 6
we are now entrusting our hospital with ID number: to take charge of our online drug procurement and other related work in your company.
period of validity: from year month day to year month day.
Copy of legal person's ID card
Copy of agent's ID card
xxxx Hospital
Power of Attorney of xx Hospital 7
According to Article 56 of Chapter VII of the Tort Liability Law of the People's Republic of China, if the opinions of patients or their close relatives cannot be obtained due to emergency such as saving dying patients, it shall be approved by the person in charge of the medical institution or the authorized person in charge. Corresponding medical measures can be implemented immediately ",Article 1 of the Basic Specification for Medical Record Writing" …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Gender: female; Nationality: Han nationality Position: president of the hospital, legal representative
Trustee: 1. Vice president of business and cadre of medical department
2. Chief duty of the hospital
Authorized matters:
In case of emergency such as saving dying patients, if the opinions of the patients or their close relatives cannot be obtained, the trustee shall execute the approval right of the person in charge of the medical institution to immediately implement corresponding medical measures for the patients.
authorization period: long term.
client:
2xxxxxx hospital power of attorney 8
client:
gender:
age:
tel:
valid ID number:
address:
relationship with patients: □ spouse □ children □ parents □ friends □ others. During my stay in the hospital, I solemnly entrust you as my agent to exercise the right of informed consent during my stay in the hospital, and perform the corresponding signing procedures. The signature of the authorized representative is deemed as my signature.
the patient shall bear the consequences after the client signs the consent form.
Patient's signature: (or handprint) xx, xxxx
Trustee's signature: (or handprint) xx, xxxx
Doctor's signature: xxXX
XX, XXXX 9
Power of attorney
This patient _ _ _ _ _ _ _ _ _ _ _
To this hospital
Trustee: ID number: Tel:
Client: ID number: Tel:
Year, Month, Day, Hospital Power of Attorney 1
Patient's name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Client (patient himself): gender and age
Valid ID number: Address: Trustee: Gender and age Tel: Valid ID number: Address: Relationship with the patient: □ spouse □ children □ parents □ other close relatives □ colleagues □ friends
The trustee's authority is: to know the patient's condition, medical measures and medical risks on his behalf; Exercising the right to choose and decide on the basis of medical informed consent, and performing the corresponding signature procedures, including the following situations:
□ When anesthesia and surgery are performed on the patient himself, and special examination and treatment are performed on him;
□ When the condition changes and rescue is needed;
□ In case of emergency during rescue or operation, it is necessary to change the scheduled operation method and operation scheme, carry out emergency blood transfusion, remove organs or larger tissues, and ligate important blood vessels;
□ When using expensive drugs, consumables or conducting special inspection with high price;
□ Patients with different types of insurance, such as public medical care, social medical insurance for serious illness, and new rural cooperative medical care, use specific drugs or take specific medical measures to diagnose and treat diseases beyond the prescribed reimbursement scope;
□ When it is necessary to transfuse blood and blood products to the patient himself or take experimental treatment;
□ When artificial organs or other medical biomaterials need to be implanted;
□ When other family members of the patient refuse to use the drugs and measures for diagnosis and treatment.
□ Other conditions encountered in surgical treatment and diagnosis and treatment: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
patient's signature: _ _ _ _ _ _ _ _
date of signature: _ _ _ _ _ _ _ _ _
place of signature: hospital power of attorney 11
client (patient himself): gender and age
valid certificate number: address:
During my stay in the hospital, I solemnly entrust you as my agent to exercise the right of informed consent during my stay in the hospital, and perform the corresponding signing procedures. The signature of the authorized representative is deemed as my signature.
the patient shall bear the consequences after the client signs the consent form.
signature of the patient: (handprint)
signature of the trustee: (handprint)
power of attorney of the hospital on 2xx x x x 12
_ _ _ _ _ _ _ _ _ _ (name of the tenderee):
_ _ _ _ _. The legal representative authorizes _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ The authorized person has no right to delegate. Hereby entrust.
signature of legal representative: _ _ _ _ _ _ _ _ _ _ _ _ _ _ (official seal of legal person)
name of bidder (official seal): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
job title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ID number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ < True: _ _ _ _ _ _ _ _ _ _ _ _ _ _____
Tel: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Code: _ _ _ _ _ _ _ _ _ _ _ _
Address: _ _ _ _ _ _ _ _ _
Principal: xxx Gender: _ _ _ _ _ _ Age: _ _ _ _ _ _ Tel: _ _ _ _ _ > relationship with patients: □ spouse □ children □ parents □ friends
□ other close relatives □ colleagues □ others
I was hospitalized due to illness on xx. During my stay in the hospital, I solemnly entrust you as my agent to exercise the right of informed consent during my stay in the hospital, and perform the corresponding signing procedures. The signature of the authorized representative is deemed as my signature.
the patient shall bear the consequences after the client signs the consent form.
patient's signature: _ _ _ _ _ _ _ _ _ _ _ _ (or handprint) xx years x months x days x hours x minutes
trustee's signature: xxx years x months x days x hours x minutes
physician's signature: xxX
Meeting place: XX years x months x days x hours x minutes hospital.
To this hospital
Trustee: XXXX
ID number: XXXX