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Please Print Dayton Public Schools EMERGENCY MEDICAL AUTHORIZATION Teacher (or) Room/Grade School Student’s Last Student’s’s ID Number First Middle PART II: HEALTH INSURANCE Date Sex Date of

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What is emergency medical authorization form?

Emergency medical authorization form is a legal document that allows a designated individual or healthcare provider to make medical decisions on behalf of someone who is unable to do so themselves in case of emergency.

Who is required to file emergency medical authorization form?

Any individual who wishes to designate someone to make medical decisions on their behalf in case of emergency is required to file an emergency medical authorization form.

How to fill out emergency medical authorization form?

To fill out an emergency medical authorization form, you typically need to provide your personal information, including your name, contact details, and relevant medical information. You also need to designate the person who will make medical decisions on your behalf, along with their contact information.

What is the purpose of emergency medical authorization form?

The purpose of an emergency medical authorization form is to ensure that medical decisions can be made promptly and accurately in case of emergency, especially when the person affected is unable to provide informed consent or communicate their wishes.

What information must be reported on emergency medical authorization form?

The information reported on an emergency medical authorization form may vary, but typically it includes the individual's personal information, relevant medical history, contact details of designated decision-maker, and any specific directives or preferences regarding medical treatment.

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