Medical: templates and forms
3 forms available to fill out or download.
Complaint about a medical facility (Poland)
A complaint to the head of a Polish hospital, clinic or practice about treatment, service or a breach of patient rights — a refused service, missing information, poor treatment, records withheld: the patient's details, the date and department, what happened, the action expected and a request for a written answer within 30 days. It notes that the complaint does not close the route to the Patient Rights Ombudsman, the National Health Fund or the courts.
Request for access to medical records (Poland)
A request to a Polish hospital, clinic or practice for a patient's medical records: the patient's details and PESEL, what records and which treatment period, who is asking — the patient, a legal representative, an authorised person or a close relative of a deceased patient — and the form to underline: inspection, a paper or electronic copy, an extract or a transcript. It reminds the provider that the first copy in the requested scope is free for the patient (Patient Rights Act).
Parental consent to a child's medical care while with another carer
A parent's written consent in Poland to examinations and treatment of a child while someone else looks after them — grandparents, a camp leader, a school trip — authorising that person to receive health information and collect records. A carer who is not a parent can only agree to an examination on their own, and higher-risk procedures need the parent's separate consent; the document says so plainly and gives the parent's phone number and the child's allergies and medicines.