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North Carolina Department of Health and Human Services Division of Social Services General Authorization for Treatment and Medication Instructions Purpose and Use The purpose of the DSS1812 General
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How to fill out general authorization for treatment
How to fill out general authorization for treatment
01
Start by obtaining a general authorization for treatment form from the appropriate healthcare provider or facility.
02
Read the instructions carefully to understand what information needs to be provided in the form.
03
Fill out your personal details like name, address, date of birth, and contact information.
04
Provide details about your medical history, including any existing conditions, medications, and allergies.
05
Specify the healthcare providers or facilities you authorize to treat you.
06
If there are any specific treatments or procedures you want to authorize or restrict, mention them clearly.
07
Sign and date the form to confirm your consent and understanding.
08
Keep a copy of the filled-out form for your records and submit the original to the healthcare provider or facility.
09
Make sure to review and update the authorization periodically as needed.
Who needs general authorization for treatment?
01
Anyone who is seeking medical treatment from a healthcare provider or facility may need a general authorization for treatment.
02
This includes individuals of all age groups, from infants to adults.
03
Patients, legal guardians, or individuals with legal authority to make healthcare decisions on behalf of others often need to fill out this authorization.
04
It is important for ensuring that healthcare providers have consent to diagnose, treat, and provide necessary medical care.
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