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WCHS FDC-10 (01/2004) Emergency Medical Authorization on Form I/we, the undersigned, give permission for, Name of Provider Day Care Provider ... Parent Signature Date.

How to fill out emergency medical authorizati on

How to fill out emergency medical authorization:

1. Start by obtaining the correct form: You can usually find emergency medical authorization forms either online or from your child's school, daycare, or healthcare provider. Make sure you have the most up-to-date version.
2. Provide personal information: Begin by filling in your child's full name, date of birth, and any other required personal information. Include your contact information as well, so that you can be reached in case of an emergency.
3. Provide emergency contacts: Specify the names, phone numbers, and relationships of two or more emergency contacts who can be reached if you cannot be reached during an emergency. It's important to choose reliable individuals who can make decisions on behalf of your child if necessary.
4. Medical information: Include relevant medical history, allergies, chronic conditions, and any medications your child is currently taking. This information is crucial for healthcare providers to understand your child's medical needs in case of an emergency.
5. Consent for medical treatment: Specify your consent for medical treatment and any limitations or preferences you may have. You may want to include details such as preferred healthcare providers or hospitals, if applicable.
6. Sign and date the form: Once you have completed all the necessary sections, sign and date the form. Some forms may require a witness or notary public, so be sure to follow any specific instructions provided.

Who needs emergency medical authorization?

Emergency medical authorization forms are typically needed for minors, such as children or teenagers, who may require medical attention when their parents or legal guardians are not present. These forms are often required by schools, daycares, or organizations where children participate in activities without direct parental supervision. It is important to consult the specific guidelines and requirements of the institution you are dealing with to determine who exactly needs emergency medical authorization.

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