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Cartersville Heights City School District 4500 Cartersville Center Road Cartersville Heights, Ohio 4412820182019 EMERGENCY MEDICAL AUTHORIZATION FORM Purpose: To enable parents and guardians to authorize
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How to fill out emergency medical authorization form
How to fill out emergency medical authorization form
01
Start by downloading and printing the emergency medical authorization form.
02
Fill in your personal information, including your name, address, and contact numbers.
03
Indicate your emergency contact person, providing their name, relationship to you, and their contact numbers.
04
Specify any medical conditions or allergies that you have, along with the necessary medications or treatments.
05
Include your healthcare provider's name and contact information.
06
Sign and date the form at the bottom.
07
Make multiple copies of the completed form to keep in easily accessible places like your wallet, car, and home.
08
Ensure that your emergency contact person and healthcare provider have copies of the form as well.
Who needs emergency medical authorization form?
01
Anyone who wishes to ensure their medical needs are properly addressed in case of an emergency needs an emergency medical authorization form.
02
This form is particularly important for individuals with pre-existing medical conditions, allergies, or those who require specific medications or treatments.
03
Parents or legal guardians should also complete this form for their children to authorize medical treatment on their behalf in emergencies.
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What is emergency medical authorization form?
An emergency medical authorization form is a legal document that allows someone else to make medical decisions on behalf of an individual in case of an emergency.
Who is required to file emergency medical authorization form?
Anyone who wants to designate another individual to make medical decisions for them in case they are unable to do so themselves.
How to fill out emergency medical authorization form?
To fill out an emergency medical authorization form, you must provide your personal information, the name of the person who will be making medical decisions for you, and any specific medical instructions or preferences you may have.
What is the purpose of emergency medical authorization form?
The purpose of an emergency medical authorization form is to ensure that your medical wishes are respected and followed in case you are unable to communicate them yourself.
What information must be reported on emergency medical authorization form?
The emergency medical authorization form should include your personal information, the name and contact information of the person designated to make medical decisions for you, any specific medical instructions or preferences, and witness signatures if required.
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