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EMERGENCY MEDICAL AUTHORIZATION PART 1 OR 2 MUST BE COMPLETEDPlease PRINTStudents Name: ___ PART 1 (TO GRANT CONSENT) In the event reasonable attempts to contact me at ___ or at ___ have been unsuccessful,
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How to fill out emergency medical authorization
How to fill out emergency medical authorization
01
Obtain the correct form for emergency medical authorization.
02
Fill out the patient's personal information, including name, date of birth, and contact information.
03
Provide emergency contact information for someone who can be reached in case of an emergency.
04
List any known medical conditions or allergies that the patient has.
05
Include information about any medications that the patient is currently taking.
06
Sign and date the form to confirm that the information provided is accurate.
Who needs emergency medical authorization?
01
Emergency medical authorization is typically needed for minors who are participating in activities where they may require medical attention without a parent or guardian present.
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What is emergency medical authorization?
Emergency medical authorization is a form that gives consent for medical treatment in case of an emergency when the individual is unable to provide consent themselves.
Who is required to file emergency medical authorization?
Parents or legal guardians of minors, individuals with special medical conditions, or anyone who wants to ensure they receive appropriate medical treatment in an emergency.
How to fill out emergency medical authorization?
The form typically requires personal information, emergency contact details, medical history, insurance information, and specific medical treatment preferences.
What is the purpose of emergency medical authorization?
The purpose is to ensure that individuals receive prompt and appropriate medical treatment in case of an emergency when they are unable to communicate their wishes.
What information must be reported on emergency medical authorization?
Personal information, emergency contact details, medical history, insurance information, and specific medical treatment preferences.
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