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Form #717

Authorization to School

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Authorization to School - Emergency Medical Treatment for Minor (Free Legal Form)

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AUTHORIZATION TO SCHOOL

 EMERGENCY MEDICAL TREATMENT FOR MINOR

 

 

Authorization

 

I, ______________________, of __________________________________________ (address), am the ______________________ (father/mother/legal guardian) of ______________________, a minor, of _____________________________________ (address), who attends ____________________________________ (name of school), located at ____________________________________________________ (address).

 

In the event all reasonable attempts by authorized school personnel to contact me at _____________ (phone number) or to contact ________________________________ (other parent/guardian) at ______________ (phone number) have been unsuccessful, I give my consent for:

 

1.  The administration of any treatment deemed necessary by _____________________ (preferred physician) or ___________________________ (preferred dentist), or, in the event the appropriate preferred practitioner is not available, by another licensed physician or dentist; and

 

2.  The transfer of the minor to ________________________ (preferred hospital) or any hospital reasonably accessible.

 

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians concurring in the necessity for such surgery are obtained prior to the performance of such surgery.

 

The following information is needed by any hospital or practitioner not having access to the minor's medical history:

 

Allergies: ______________________________________________________________

 

Medication being taken: __________________________________________________

 

Date of last tetanus shot: __________________________________________________

 

Physical impairments: ____________________________________________________

 

Other pertinent facts to which physician should be alerted: ______________________________________________________________________

 

 

 

______________________________                      __________________________

(Signature)                                                                                        (Date)

Contributed by
Asian Investment Advisers
 
Name of Firm Asian Investment Advisers
Total Forms Contributed 61
 

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Submissions to this site, including any legal or business forms, posts, responses to questions or other communications by contributors are not intended as and should not be construed as legal advice. You are strongly encouraged to consult competent legal council before engaging in any action based upon content contained on this site.

These downloadable forms are only for personal use. Retransmission, redistribution, or any other commercial use is prohibited. This includes reposting forms from this site to another site offering free legal or other document forms for download.

Please note that the donator may have included different usage terms regarding this form, and you agree to abide by these terms. It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.

Your use of this site constitutes your acceptance of our terms of use and your agreement to hold this site, its officers, employees and any contributors to this site harmless for any damage you might incur from your use of any submissions contained on this site. If you do not agree to the above terms, please do not proceed.

These forms are provided to assist business owners and others in understanding important points to consider in different transactions. They are offered with the understanding that no legal advice, accounting, or other professional service is being offered by these documents or on this website. Laws vary in the different states. Agreements acceptable in one state may not be enforced the same way under the laws of another state. Also, agreements should relate specifically to the particular facts of each situation. Therefore, it is important to consult legal counsel whenever utilizing these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com is not engaged in recommending or referring members on the site or making claims about the competence, character or qualifications of its participating members.
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Comments

submitted 10/2/2008
by DavidMarshall  

"The Father is wise to get parents to sign this form. Whether you are running a commercial operation, or a community-based or charitable operation, you need the power to look after children in your care. The law is consistent across all states. A minor child cannot give consent for medical treatment. This can only be given by a parent or legal guardian. If no one in a parental role is available, the physician or hospital must apply to the court for an order unless it is a case of urgent necessity to save the child's life. Thus, with one of these forms held by the community center, the Father can authorize whatever care is necessary if the parents are not immediately available. I wish all communities were as well-prepared to deal with emergencies."
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Keywords: legal forms, family, minor, emergency, medical treatment

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