Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
Medical Authorization Form For Minor In Contra Costa - Authority for Release of Medical Information
Category:
State:
Multi-State
County:
Contra Costa
Control #:
US-00426
Format:
Word
Instant download
Description
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, (an adult into whose care the minor has been entrusted) to consent to medical treatment of. Applicants who are under the age of 18 are considered minors in the United States.Once a person reaches 18 years of age, they are considered an adult. Create a quick and hassle-free Medical Consent Form for minors with this easy-to-use template. Ensure smooth communication and authorization for medical care. This form allows a relative to enroll a child in school and get medical treatment. To order a birth certificate in person, please come to our office during normal business hours.