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EMERGENCY MEDICAL AUTHORIZATION / LIABILITY RELEASE Circle Christian School, Inc. DISNEY WORLDS NIGHT OF JOY SEPTEMBER 11, 2015, Student FULL Name: Home Phone: Street Address: Date of Birth: VERIFICATION
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Begin by providing your personal information, including your full name, date of birth, and contact information.
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Indicate your relationship to the patient, whether you are the patient yourself or a designated representative.
03
Specify the medical condition or situation that requires emergency medical treatment. Provide clear and concise details to ensure accurate understanding.
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Include any relevant medical history or pre-existing conditions that may impact the emergency medical treatment.
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State the preferred hospital or healthcare facility where you would like the patient to be transported or treated, if applicable.
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If you have any specific instructions or preferences for the emergency medical personnel, such as medication allergies or special requirements, ensure to include them in this section.
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Who needs b - emergency medical:

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Individuals who have a chronic health condition or a history of severe medical emergencies that may require immediate medical attention.
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Family members or legal guardians of individuals who are unable to make medical decisions for themselves due to age, cognitive impairment, or other incapacitating factors.
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Anyone participating in activities or occupations with a higher risk of accidents or injuries, such as construction workers, athletes, or outdoor enthusiasts.
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b - emergency medical is a form used to report emergency medical treatment provided to an employee while at work.
Employers are required to file b - emergency medical for any employee who has received emergency medical treatment at work.
B - emergency medical should be filled out with details of the emergency medical treatment provided, including the date, time, location, and nature of the injury.
The purpose of b - emergency medical is to document and report any emergency medical treatment provided to employees while at work.
Information such as the date, time, location, and nature of the injury must be reported on b - emergency medical.
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2015 Kentucky Florida circlechristianschool childs undersigned FOREGOING hereto HOSPITALIZATION contractual inclusive indemnity withstanding THERETO pertains FL VERIFICATION waiver org thereof expressly medicines SUBSEQUENT prohibited resulting invalid ch

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