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EMERGENCY MEDICAL AUTHORIZATION FOR PARTICIPANTS 18 YEARS OF AGE AND UNDER PARTICIPANT NAME GROUP LEADER ADDRESS TELEPHONE Purpose: To enable parents and guardians to authorize the provision of emergency

How to fill out emergency medical authorization for

How to fill out emergency medical authorization form:

1. Begin by providing your personal information, such as your full name, address, date of birth, and contact number. Ensure the information is accurate and up-to-date.
2. Specify your emergency contact details, including the name, relationship, and contact number of the person you would like to be contacted in case of an emergency.
3. Indicate any known medical conditions or allergies that you have. This information will help medical professionals provide appropriate care and avoid any potential complications.
4. Include a list of your current medications, including the dosage and frequency of each medication. This information is crucial for healthcare providers to ensure that they do not administer any medications that may interact negatively with your existing ones.
5. Provide details about your primary healthcare provider, such as their name, contact number, and address. This information will help emergency personnel reach out to your regular doctor for additional medical history if needed.
6. Specify any specific medical treatments or procedures that you authorize in case of an emergency. For example, you may provide explicit instructions regarding resuscitation, blood transfusions, or surgeries.
7. Sign and date the form. Some healthcare providers may require the form to be notarized for validity. Make sure to follow any additional guidelines provided by the organization or institution requesting the form.

Who needs emergency medical authorization form:

1. Parents or legal guardians of minors may need emergency medical authorization forms to grant permission for medical treatment in case of an emergency when they are not present.
2. Individuals with known medical conditions, allergies, or taking medications should also consider having an emergency medical authorization form. This will help healthcare providers quickly access vital information and provide appropriate care during emergencies.
3. People who frequently engage in activities that carry a higher risk of accidents or injuries, such as extreme sports enthusiasts or frequent travelers, may also find it beneficial to have an emergency medical authorization form.

Remember, it is essential to consult with your healthcare provider or legal advisor to ensure that the emergency medical authorization form meets your specific needs and adheres to any legal requirements in your jurisdiction.

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