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202223 EMERGENCY INFORMATION COMPLETED BY PARENT/GUARDIANPlease print or type Student Name: ___Date of Birth: ___Parent(s) Name: ___Address: ___Cell Phone: ___Grade: ___Home Phone: ___Place of Employment:
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How to fill out emergency medical authorization

01
Gather all necessary information such as name, date of birth, medical history, allergies, current medications, and emergency contact information.
02
Fill out the designated sections on the form with accurate and up-to-date information.
03
Make sure to sign and date the authorization form.
04
Provide a copy of the completed form to the appropriate parties such as schools, daycares, or medical facilities.

Who needs emergency medical authorization?

01
Anyone who may require medical attention in case of an emergency needs to have an emergency medical authorization form on file. This includes children, elderly individuals, individuals with chronic health conditions, and those with severe allergies or other medical concerns.
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Emergency medical authorization is a form that grants permission for medical treatment in case of emergency.
Parents or legal guardians of minors are required to file emergency medical authorization.
Emergency medical authorization can be filled out by providing personal information, medical history, emergency contact details, and signature.
The purpose of emergency medical authorization is to ensure that medical treatment can be administered promptly in case of emergency.
Information such as allergies, current medications, medical conditions, emergency contact details, and insurance information must be reported on emergency medical authorization.
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