Limited Power of Attorney for Medical Consent for Health Care of Minor Child Sample Clauses

Limited Power of Attorney for Medical Consent for Health Care of Minor Child. You authorize FBC to administer general first aid treatment for minor injuries or illnesses experienced by you or your child (whichever is relevant) when participating in the Activity except for the following first aid treatment: You also authorize FBC, in the event that you are disabled, cannot be contacted or if any urgency dictates, to act in loco parentis for your child in respect of any circumstances, including any accident or illness, which may necessitate medical treatment, including surgery, hospitalization, and administration of drugs or other therapeutic measures for the health, safety, and care of your child, and authorize and execute any informed consent for any such treatment or surgery which FBC, in its sole discretion, may deem necessary. Such consent shall have the same force and effect as though the undersigned were personally present and acting, and hereby ratifying and confirming whatever FBC does by authority of this instrument. Medical treatment for your child may also include dental surgery, x-ray, blood transfusion, anesthetic and medication, provided any such medical treatment is performed by a duly licensed practitioner. You hereby accept full liability for all costs incurred through such medical treatment for your child. You have the legal right to delegate such medical consent to FBC. A representative of FBC, the proxy decision maker, shall be an adult who is legally and medically competent to exercise the authority so delegated in this Agreement. HIPAA Release Authority. FBC (and its representative) shall be treated as you would be with respect to our rights regarding the use and disclosure of your child's individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. § 1320d and 45 C.F.R. §§ 160 through 164, and the Health Information Technology for Economic and Clinical Health Act ("HITECH Act"). You authorize any physician, health care professional, dentist, health plan, hospital, clinic, laboratory, pharmacy, or other covered health care provider, any insurance company, and the Medical Information Bureau, Inc. or other health care clearinghouse that has provided treatment or services to your child, or that has paid for or is seeking payment from you for such services, to give, disclose and release to FBC, without restriction, all of your child's individually identifiable hea...
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