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EMERGENCY MEDICAL AUTHORIZATION FORM (Ohio Revised Code 3313.712) Centerville City Schools Name School Date of Birth School Year Address City/Zip Grade Phone Purpose To enable parents and guardians

How to fill out emergency medical authorization form

How to fill out emergency medical authorization form

1. Obtain the emergency medical authorization form from the relevant authorities or download it online.
2. Read the instructions and ensure that you understand the purpose and requirements of the form.
3. Provide your personal information such as full name, date of birth, and contact details.
4. Include the name and contact information of your chosen emergency contact person.
5. Specify any existing medical conditions, allergies, or medications that you are currently taking.
6. Indicate your preferred healthcare provider or hospital in case of an emergency.
7. Review the form for accuracy and make any necessary corrections.
8. Sign and date the form to indicate your consent and acknowledgement of the provided information.
9. Make copies of the completed form and keep one with you, provide one to your emergency contact, and give another to your healthcare provider if required.
10. Store the form in a safe but easily accessible place, informing your family members of its location.

Who needs emergency medical authorization form?

1. Anyone who wishes to ensure proper medical treatment and decision-making in the event of an emergency should consider filling out an emergency medical authorization form. This includes individuals with chronic illnesses or allergies, elderly individuals, individuals at higher risk of medical emergencies, parents or legal guardians of minor children, and individuals who have appointed someone as their healthcare power of attorney.

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What is emergency medical authorization form?

Emergency medical authorization form is a document that allows designated individuals to make medical decisions on behalf of someone in case of an emergency.

Who is required to file emergency medical authorization form?

Parents, guardians, or caregivers of minors or individuals who are unable to make medical decisions for themselves are required to file emergency medical authorization form.

How to fill out emergency medical authorization form?

Emergency medical authorization form can be filled out by providing personal information, contact information, medical history, emergency contact information, and medical treatment preferences.

What is the purpose of emergency medical authorization form?

The purpose of emergency medical authorization form is to ensure that appropriate medical decisions can be made on behalf of an individual in case of an emergency.

What information must be reported on emergency medical authorization form?

Information such as personal details, emergency contacts, medical history, allergies, current medications, insurance information, and treatment preferences must be reported on emergency medical authorization form.