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Our Savior Lutheran School PreschoolGrade 8 1500 San Simeon Way, Benton, Missouri 63026 www.oursaviorlcs.org 6363437511 EMERGENCY PROCEDURE AND MEDICAL RELEASE FORM 20172018 School Year Student Grade
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01
Read the medical release form carefully to understand the information required.
02
Provide your personal details such as name, date of birth, address, and contact information.
03
Include information about your medical history, allergies, and current medications.
04
Specify the name and contact information of your primary care physician.
05
Indicate your preferred emergency contacts and their phone numbers.
06
Sign and date the medical release form to acknowledge your consent.
07
Make copies of the filled-out form for your own records.
08
Submit the form to the relevant healthcare provider or organization.

Who needs medical release form?

01
Parents or legal guardians of minor children who may require medical treatment in their absence.
02
Adults who want to authorize someone else to make medical decisions on their behalf in case of incapacitation.
03
Patients who are seeking specialized medical care or treatment from a different healthcare provider.
04
Individuals participating in certain activities or events that require medical release forms, such as sports tournaments or organized trips.
05
Employers or organizations that require their employees or members to have medical release forms on file.
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A medical release form is a document that allows healthcare providers to disclose a patient's medical information to a designated person or organization.
The patient or their legal guardian is typically required to file a medical release form.
To fill out a medical release form, the patient or legal guardian must provide their personal information, specify who can access their medical records, and sign the form.
The purpose of a medical release form is to ensure that healthcare providers have permission to disclose a patient's medical information to designated individuals or organizations.
The information reported on a medical release form typically includes the patient's name, date of birth, contact information, and the names of individuals or organizations authorized to access their medical records.
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