Authorization for Medical Treatment of a Minor Clause Samples
Authorization for Medical Treatment of a Minor. I authorize Growing Kids Learning Center to transport my minor child and to consent to any necessary medical examination, diagnosis, and care, including but not limited to surgery or other form of treatment, for my minor child, under the general supervision and on the advice of any physician licensed to practice in Indiana. This authorization is for emergency purposes only, and I understand and agree that Growing Kids Learning Center will have the sole discretion to decide whether an emergency exists for purposes of this authorization.
Authorization for Medical Treatment of a Minor. In the event of an emergency requiring a physician’s care, do you wish us to call your family physician? Y N If yes, please provide the following:
Authorization for Medical Treatment of a Minor. In accordance with the New Jersey Statute, I(we) , give authorization to a physician or surgeon, licensed under the provisions of the Medical Practice Act, for _ to receive care and/or emergency medical treatment when necessary.
Authorization for Medical Treatment of a Minor. In the event of a medical issue requiring a physician’s care, would you like us to call your family physician? Yes No If yes, please provide the following information: Physician’s Name:_ Phone Number: