Get the free Emergency Medical Authorization Form 20 -20 ORC 3313 - hicksvilleschools

20152016 Emergency Medical Authorization Form 20142015 O.R.C. 3313.719 Please verify the information below, write any corrections, and return the form to the school. STUDENT AND PARENT/GUARDIAN INFORMATION

How to fill out emergency medical authorization form

How to fill out emergency medical authorization form:

1. Begin by carefully reading through the form and familiarizing yourself with its sections and requirements.
2. Start by entering your personal information, such as your full name, date of birth, and contact details.
3. Provide the necessary information about your emergency contact. This should include their full name, relationship to you, phone number, and address. Ensure that this person is someone who can make medical decisions on your behalf in case of an emergency.
4. Indicate any specific medical conditions or allergies that you have. It's important to be thorough and accurate in providing this information to ensure appropriate medical care is provided.
5. Include details about your primary healthcare provider, such as their name, address, and contact information. This will help healthcare professionals coordinate your care in case of an emergency.
6. If applicable, specify any medications you take regularly or any medical devices you rely on. Include the name of the medication, dosage, frequency, and any important instructions.
7. Sign and date the form, and if required, have it witnessed or notarized as per the instructions provided.
8. Keep a copy of the completed form for yourself and make sure to provide a copy to your emergency contact person.
9. Review the form periodically and update it as necessary, especially if there are any changes in your medical condition, contact details, or healthcare provider.

Who needs emergency medical authorization form:

1. Parents or guardians of minors: If you have a child who requires emergency medical care while in someone else's care, it's crucial to have an emergency medical authorization form in place. This allows the caregiver to make medical decisions on behalf of the child when the parent or guardian is not present.
2. Adults without immediate family nearby: If you live alone or don't have close family members in the vicinity, having an emergency medical authorization form ensures that someone you trust can make medical decisions for you during an emergency.
3. Individuals with chronic medical conditions: If you have a chronic illness or medical condition that may require emergency treatment, having an emergency medical authorization form grants your emergency contact the authority to make medical decisions for you when you are unable to do so.
4. Individuals participating in high-risk activities or events: If you're engaging in activities that carry a higher risk of injury or medical emergencies, such as extreme sports or adventurous outings, it's advisable to have an emergency medical authorization form in place. This ensures that someone trusted can make prompt medical decisions on your behalf if needed.
5. Individuals with allergies or specific medical needs: If you have severe allergies, require specific medications, or have any other special medical needs, having an emergency medical authorization form can provide crucial instructions to healthcare providers in case of an emergency.

Remember, the need for an emergency medical authorization form may vary depending on individual circumstances, and it's always recommended to consult with legal or healthcare professionals for specific advice tailored to your situation.

For pdfFiller’s FAQs

What is emergency medical authorization form?

An emergency medical authorization form is a document that grants permission for medical treatment in case of an emergency.

Who is required to file emergency medical authorization form?

Parents or legal guardians of minors are required to file emergency medical authorization form.

How to fill out emergency medical authorization form?

To fill out emergency medical authorization form, you need to provide personal information, emergency contacts, medical history, and consent for medical treatment.

What is the purpose of emergency medical authorization form?

The purpose of emergency medical authorization form is to ensure that medical personnel have legal consent to provide necessary treatment in case of an emergency.

What information must be reported on emergency medical authorization form?

Information such as patient's name, date of birth, medical conditions, allergies, current medications, emergency contacts, and consent for treatment must be reported on emergency medical authorization form.

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