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Granville Christian Academy EMERGENCY MEDICAL AUTHORIZATION Student Name Date of Birth Last First MI Address Phone Street Grade City Teacher Public school district of residence PURPOSE: To enable
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How to fill out emergency medical authorization
How to fill out emergency medical authorization:
01
Start by writing your personal information, including your full name, date of birth, and contact information. This will help healthcare providers identify you quickly in case of an emergency.
02
Next, provide the contact information of your primary healthcare provider or physician. This will help emergency medical personnel reach out to them for any necessary information or guidance.
03
Specify your medical history, including any pre-existing conditions, allergies, or medications you are currently taking. This information is crucial for healthcare providers to tailor their emergency treatment based on your specific needs.
04
Include emergency contact details for one or more individuals who should be contacted in case of an emergency. Make sure to include their full names, phone numbers, and their relationship to you.
05
Provide consent for medical treatment by signing and dating the authorization form. This indicates that you understand and agree to the information provided within the authorization.
06
Lastly, ensure that you review the form for accuracy and completeness before submitting it to the relevant authority or organization. Consider keeping a copy of the filled-out form for your records.
Who needs emergency medical authorization?
Emergency medical authorization is essential for anyone who may require immediate medical attention but is unable to communicate their medical history or preferences. This includes individuals with chronic illnesses, allergies, or specific medical conditions, as well as those who frequently engage in high-risk activities. Having a completed emergency medical authorization form can ensure timely and appropriate medical care, particularly when one is unable to provide necessary information themselves.
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