WA Youth Soccer Medical Release Form 2011 free printable template

Washington Youth Soccer 500 S. 336th Street, Suite #100 Federal Way, Washington 98003-6389 PHONE (253) 4-SOCCER FAX (253) 925-1830 TOLL FREE 1-877-424-4318 www.washingtonyouthsoccer.org MEDICAL RELEASE

How to fill out WA Youth Soccer Medical Release Form

How to fill out WA Youth Soccer Medical Release Form

1. Obtain the WA Youth Soccer Medical Release Form from the official website or your local soccer organization.
2. Fill in the player's full name at the top of the form.
3. Provide the player's date of birth and age.
4. Enter the parent or guardian's name and their contact information.
5. List any medical conditions, allergies, or medications that the player is taking.
6. Provide the name and phone number of the family physician or medical provider.
7. Sign and date the form to give permission for emergency medical treatment.
8. Review the completed form for accuracy and completeness before submission.

Who needs WA Youth Soccer Medical Release Form?

1. All players participating in WA Youth Soccer programs are required to have a signed Medical Release Form.
2. Parents or guardians of youth players must fill out the form to ensure that medical professionals have necessary health information in case of emergencies.
3. Coaches and team officials may also need to review the form for pertinent medical information.

Instructions and Help about WA Youth Soccer Medical Release Form

Intro music Bowling Green Ohio Should I sing the paperwork that the insurance company sends me Hi this Chuck Book again An initial question I'm often asked it should, I sign the medical authorizations that are sent to me by the insurance adjuster The answer is absolutely not So what's going on here The insurance company signs you a medical authorization If you sign the medical authorization that entitles the insurance company to get all your medical records All your medical records out of this accident and all the medical records that you've ever had your entire life So what does that mean If you have any sort of personal confidential medical issues psychological issues gynecological issues sexually transmitted diseases or family problems all of that is going to be in your medical records so in effect you've kind of waived your doctor patient privilege A better thing to do is to allow your attorney to order up your medical records then you and the attorney can discuss the medical records up front, so you can make an informed decision as far as what medical records are given to the insurance adjuster and if there's any sort of confidential information we together the client and the attorney can go to the court and ask for an in camera inspection, so we do not have to release those medical records to the insurance company and the other side

People Also Ask about

What is a release authorization form?

A HIPAA authorization form, also known as a HIPAA release form, is a document that individual signs for their health provider before the entity may use or disclose their protected health information (PHI).

What is the law for medical record release in Washington state?

Washington medical records laws state that only the patient may authorize disclosure of medical records to anyone other than health care providers, penal institution officials, or public health authorities.

What is required on a authorization to release information?

A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.

What is a medical release?

What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.

What is included on a release of medical information form?

A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed. An expiration date or expiration event when consent to use/disclose the information is withdrawn.

What is an authorization to release for?

By setting up a Release Authorization (ARI), you are giving customer service your permission to disclose information about your accounts to another person. Typically, this is used to give account access to a spouse or other family member.

What are medical releases?

What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.

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What is WA Youth Soccer Medical Release Form?

The WA Youth Soccer Medical Release Form is a document that grants permission for medical treatment for a minor participant in youth soccer events in Washington State. It is designed to inform medical personnel about the child's health history and emergency contacts.

Who is required to file WA Youth Soccer Medical Release Form?

The WA Youth Soccer Medical Release Form must be filed by the parents or legal guardians of all minor players participating in youth soccer programs in Washington State.

How to fill out WA Youth Soccer Medical Release Form?

To fill out the WA Youth Soccer Medical Release Form, parents or guardians need to provide the player's personal information, emergency contact details, relevant medical history, and allergies if any, ensuring all sections are completed accurately and clearly.

What is the purpose of WA Youth Soccer Medical Release Form?

The purpose of the WA Youth Soccer Medical Release Form is to ensure that medical professionals have immediate access to important health information regarding a player in case of an injury or medical emergency during practices or games.

What information must be reported on WA Youth Soccer Medical Release Form?

The WA Youth Soccer Medical Release Form must include the player's full name, date of birth, insurance information, allergies, pre-existing medical conditions, emergency contacts, and the parent's or guardian's signature authorizing medical treatment.