Common use of Emergency Medical Treatment Clause in Contracts

Emergency Medical Treatment. In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of an emergency, if you are unable to reach me at the above numbers, contact: at . (Name) (Phone Number) MEDICAL INFORMATION: Medication my child is taking at present: Allergies: Family Health Plan Carrier Number: Family Doctor: Phone Number: As a parent or guardian, I agree to all of the above stated considerations and conditions. Signature: Date:

Emergency Medical Treatment. In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by a doctor the hospital or hospitaldoctor. In the event of an emergency, if you are unable to reach me at the above numbersnumbers listed herein, contact: at . (Name) (Phone Number) MEDICAL INFORMATIONName & Relationship: Medication my child is taking at presentPhone: AllergiesFamily Doctor: Phone: Family Health Plan Carrier NumberCarrier: Family DoctorPolicy #: Phone Number: As a parent or guardian, I agree to all of the above stated considerations and conditions. Signature: Date:

Emergency Medical Treatment. In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of an any emergency, if you are unable to reach me at the above numbers, contact: at . (contact Name) (/Relation Emergency Phone Number) Number OPTIONAL MEDICAL INFORMATION: Medication my child is taking at present: Allergies: Family Health Plan Carrier Numbercarrier number: Family Doctor: Phone Number: As a parent Parent or guardianGuardian, I agree to all of the above stated considerations and conditions. Signature: Date:

Emergency Medical Treatment. In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of an emergency, if you are unable to reach me at the above numbers, contact: ________________________________________________ at _. (Name) (Phone Number) MEDICAL INFORMATION: Medication my child is taking at present: Allergies: Family Health Plan Carrier Number: Family Doctor: Phone Number: As a parent or guardian, I agree to all of the above stated considerations and conditions. Signature: Date:

Emergency Medical Treatment. In the event of an any emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of an emergency, if you are unable to reach me at the above numbers, contact: at . (Name) (Name Phone Number) Number MEDICAL INFORMATION: Medication my child is taking at present: Allergies: present Allergies Family Health Plan Carrier Number: carrier number Family Doctor: Doctor Phone Number: Number As a parent or guardian, I agree to all of the above stated considerations and conditions. Signature: Date:.

Emergency Medical Treatment. In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of an any emergency, if you are unable to reach me at the above numbers, contact: at . (Name) (contact Name Phone Number) Number MEDICAL INFORMATION: Medication my child child(ren)(specify which) is taking at present: Allergies: present Allergies (specify by child) Other Medical Conditions Family Health Plan Carrier Number: carrier number Family Doctor: Doctor Phone Number: Number As a parent Parent or guardianGuardian, I agree to all of the above stated considerations and conditions. Signature: Date:.