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MEDICAL AND MEDIA RELEASE FORM 201415 Auditions and Portfolio Reviews The New Mexico School for the Arts (NASA) is a public/private partnership comprised of the New Mexico School for the Arts, a New
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Begin by writing your full name, date of birth, and contact information at the top of the form.
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Read the instructions carefully and provide details about your medical history, including any existing conditions, allergies, or medications you are currently taking.
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Fill in the section that asks for emergency contact information, providing the names and phone numbers of individuals who should be contacted in case of an emergency.
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Ensure that you fully understand the terms and conditions of the media release portion. Decide whether you are comfortable granting consent for your image, voice, or personal information to be used in various media outlets.
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If you have any concerns or questions, it is advisable to consult with a healthcare professional or legal advisor before signing the release form.
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Sign and date the form at the designated area, indicating your understanding and agreement to the terms outlined.
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Keep a copy of the filled-out medical and media release for your records.

Who needs medical and media release:

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Individuals participating in medical research studies or clinical trials often need to fill out a medical release in order to provide consent for their medical information to be used for research purposes.
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Patients undergoing medical procedures or receiving treatment may be required to complete a medical release form, granting healthcare providers permission to share their medical records with other medical professionals or insurance companies.
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Individuals participating in media-related activities, such as interviews, photography sessions, or public events, may be asked to sign a release form allowing the use of their image, voice, or personal information for promotional or informational purposes.
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Medical and media release is a form that allows an individual to authorize the disclosure of their medical information and allow the media to use their likeness or statements.
Anyone who wishes to release their medical information or allow the media to use their likeness or statements is required to file a medical and media release form.
To fill out a medical and media release, the individual must provide their personal information, specify what information can be released, and sign the form.
The purpose of a medical and media release is to give consent for the disclosure of medical information and release of likeness or statements to the media.
The information that must be reported on a medical and media release includes personal details, authorization for medical information disclosure, and permission for media use.
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