Get the free emergency medical authorization - Heath City Schools

Printed Name of StudentSignature of Parent/GuardianDateWASHINGTON MONTESSORI SCHOOL PERMISSION FORM & EMERGENCY CONTACT INFORMATION 20172018 Authorization to Consent to Emergency Medical & Dental

How to fill out emergency medical authorization

How to fill out emergency medical authorization

1. To fill out emergency medical authorization, follow these steps:
2. Begin by writing the full name of the patient or person for whom the authorization is being given.
3. Provide the contact information of the person filling out the form, including their name, address, phone number, and email address.
4. Specify the medical conditions or allergies that the patient has, if any.
5. Include details of any medications the patient is currently taking, along with the dosage and frequency.
6. Mention any specific medical treatments or procedures that the patient should or should not receive in case of an emergency.
7. Indicate the preferred hospital or medical facility where the patient should be taken in case of emergency.
8. Provide the contact information of the patient's primary care physician or healthcare provider.
9. Include any additional instructions or information that may be relevant in an emergency situation.
10. Sign and date the authorization form, and ensure it is witnessed or notarized if required.
11. Keep a copy of the completed form for your records and make sure it can be easily accessed in case of an emergency.

Who needs emergency medical authorization?

1. Emergency medical authorization is typically needed for individuals who may require medical care in case of an emergency.
2. This includes but is not limited to:
3. - Children who are under the legal age of consent and may require medical attention when their parents or legal guardians are not present.
4. - Elderly individuals who have specific medical conditions or may be at risk of emergencies.
5. - Individuals with chronic illnesses or severe allergies.
6. - Individuals with disabilities or special needs who may need assistance in an emergency.
7. - Individuals who are traveling alone or in situations where their medical history and emergency contacts may not be readily available.
8. Having an emergency medical authorization form can help ensure that the right medical decisions are made and prevent delays in receiving necessary care in urgent situations.

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