Get the free EMERGENCY MEDICAL AUTHORIZATION - galionschoolsorg

Nursing Office Administrative Center 470 Portland Way North Gallon, Ohio 44833 TEL: 419 4683432 Faxes: 419 4684333 www.galionschools.org EMERGENCY MEDICAL AUTHORIZATION School: Student Name: Address:

How to fill out emergency medical authorization

How to Fill Out Emergency Medical Authorization:

1. Start by accessing the emergency medical authorization form. This form can typically be obtained from the school, daycare center, or healthcare provider.
2. Begin by entering the date on the designated space provided at the top of the form. Make sure to use the correct format (e.g., MM/DD/YYYY).
3. Provide the full name of the person for whom the authorization is being filled out. This could be the student, child, or patient who may require emergency medical treatment.
4. Include the complete contact information of the person filling out the authorization form. This includes the name, address, and phone number. It's important to have accurate contact information in case any further clarification is required.
5. Indicate the name and contact information of the primary healthcare provider, such as the family doctor or pediatrician. This information is vital as it allows medical professionals to quickly access crucial medical records or seek medical advice during emergencies.
6. List any known allergies or medical conditions that the person may have. This information is crucial in providing appropriate medical care and avoiding any potential adverse reactions or complications.
7. Specify any medications that need to be administered during an emergency. Include the medication name, dosage, and frequency. It's essential to be as detailed as possible to ensure proper administration.
8. Provide a list of authorized individuals who are permitted to make medical decisions on behalf of the person named in the form. This includes their full names and contact information. This ensures that only authorized individuals can give consent for medical treatment during emergencies.
9. Indicate any specific medical procedures or treatments that should or should not be performed. This may include resuscitation, blood transfusions, or other relevant medical interventions. Discuss these preferences with the healthcare provider beforehand.
10. Finally, review the completed form for accuracy and sign it. Make sure to date the document and keep a copy for your records. Notify the appropriate parties, such as the school or daycare center, about the completion of the form.

Who Needs Emergency Medical Authorization:

Emergency medical authorization is essential for individuals who may require medical treatment during an emergency but are unable to provide consent themselves. This includes children attending school or daycare, individuals with certain medical conditions or disabilities, and those who may be in temporary guardianship or under the care of a healthcare facility. Having a properly filled out emergency medical authorization form in such cases ensures that prompt and appropriate medical care can be administered when needed.

For pdfFiller’s FAQs

What is emergency medical authorization?

Emergency medical authorization is a legal document that grants permission for medical treatment in case of an emergency when the patient is unable to give consent.

Who is required to file emergency medical authorization?

Emergency medical authorization is usually filed by parents or legal guardians for children under the age of 18, or by individuals who want to designate someone to make medical decisions on their behalf.

How to fill out emergency medical authorization?

To fill out emergency medical authorization, you need to provide personal information, medical history, emergency contact details, and specify any treatments or procedures you do or do not consent to.

What is the purpose of emergency medical authorization?

The purpose of emergency medical authorization is to ensure that medical providers have permission to treat a patient in case of an emergency when the patient is unable to communicate their own medical decisions.

What information must be reported on emergency medical authorization?

Information that must be reported on emergency medical authorization includes patient's name, date of birth, medical history, allergies, emergency contact information, and specific medical treatments or procedures consented to.

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