Consent to Treat. You acknowledge and hereby authorize Practice to use and/or disclose Your health information which specifically identifies You, or which can reasonably be used to identify You, to carry out Your treatment, payment, and healthcare operations. Treatment includes but is not limited to: the administration and performance of all treatments, the administration of any needed anesthetics, the administration and use of prescribed medication, the performance of such procedures as may be deemed necessary or advisable for treatment, including but not limited to diagnostic procedures, the taking and utilization of cultures, and of other medically accepted laboratory tests, all of which in the judgment of the attending physician or their assigned designees may be considered medically necessary or advisable.
Consent to Treat. You acknowledge, consent, and hereby authorize Practice to carry out your healthcare treatment. Treatment includes but is not limited to: the administration and performance of all treatments, the administration of any needed anesthetics, the administration and use of prescribed medications, the performance of such procedures as may be deemed necessary or advisable for treatment, including but not limited to diagnostic procedures, the taking and utilization of cultures, and of other medically accepted laboratory tests, all of which in the judgment of the attending provider or their assigned designees may be considered medically necessary or advisable. You acknowledge and understand that this consent is given in advance of any specific diagnosis or treatment, that these services are voluntary, and that you have the right to refuse these services. You understand and intend this consent to be continuing in nature, even after a specific diagnosis has been made and treatment recommended. This consent will remain in full force unless revoked in writing and will not affect any actions that were taken prior to receiving your revocation.
Consent to Treat. Participant authorizes the employees, agents or other representatives of Xxxxxxx to use their discretion to administer or authorize diagnostic or medical treatment and/or to transport or to have Participant transported to a community medical facility for treatment and Participant acknowledges that the Releasees assume no responsibility or liability for any injury or damage which might arise out of or in connection with such medical response or treatment and any such action(s) related thereto shall be subject to the indemnification and hold harmless language of paragraph 2 above. Participant further understands and agrees that any such diagnosis, treatment and/or transportation will be Participant’s sole financial responsibility.
Consent to Treat. I voluntarily consent to such care and treatment as prescribed by the physician as is necessary in her/his judgement.
Consent to Treat. If Participant should suffer an injury or illness while on Xxxxxxx’ campus, Participant authorizes the employees, agents, or other representatives of the University to use their discretion to administer or authorize emergency medical treatment and/or to transport or to have Participant transported to a medical facility and Participant acknowledges that the Released Parties assume no responsibility or liability for any injury or damage which might arise out of or in connection with such medical response or treatment and any such action(s) related thereto shall be subject to the release in paragraph 4 above. Participant further understands and agrees that any such treatment will be Participant’s sole financial responsibility.
Consent to Treat. As a consenting adult, I agree to permit the students, faculty, staff and residents of The University of Texas Health Science Center at San Antonio Dental School (UTHSCSA‐DS) to provide dental care to myself, my child or patient representative as applicable.
Consent to Treat. I authorize and consent to emergency care and treatment for my child as deemed necessary by the Sports Medicine staff and contracted licensed Athletic Trainers of Wisconsin Saints., d/b/a Wisconsin Playmakers. I understand I will be contacted if additional treatment or information is needed in the event of illness or injury. I authorize the release of information related to my child’s health and injury information while participating in Wisconsin Playmakers activities for purposes of treatment and follow up care.
Consent to Treat. Patient acknowledges and hereby authorizes Medical Practice to use and/or disclose Patient’s health information, which specifically identifies the Patient, or which can reasonably be used to identify the Patient, to carry out Patient’s treatment, payment and healthcare operations. Treatment includes but not limited to services listed in Appendix 1.
Consent to Treat. Participant hereby consent to any reasonably necessary and appropriate emergency medical treatment provided by the Host, emergency medical responders, and/or other emergency or medical personnel.
Consent to Treat. I hereby authorize Heartland Family First Medical Clinic and its employees and agents to examine me/the patient named below and to furnish diagnostic and therapeutic services as they deem necessary and appropriate.
