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OFFICE USE: Patient ID___CareTaker AuthorizationPatient Name: ___ DOB: ___ Parent/Legal guardian Name: ___ IT IS BEST FOR THE PATIENTS PARENTS/LEGAL GUARDIANS TO BRING THEM TO ALL APPOINTMENTS, but

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What is care-taker authorization?

Care-taker authorization allows someone other than the parent or legal guardian to make medical decisions for a child.

Who is required to file care-taker authorization?

Any individual who will be responsible for the care and medical decisions of a child.

How to fill out care-taker authorization?

Care-taker authorization forms can typically be obtained from the child's healthcare provider or online. The form should be completed with the necessary information and signed by both the parent/legal guardian and the care-taker.

What is the purpose of care-taker authorization?

The purpose of care-taker authorization is to ensure that someone is legally authorized to make medical decisions for a child in the absence of the parent or legal guardian.

What information must be reported on care-taker authorization?

Typically, care-taker authorization forms require information such as the child's name, date of birth, the name of the care-taker, contact information, and the duration of the authorization.

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