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 With Minor In King - Authority for Release of Medical Information
Category:
State:
Multi-State
County:
King
Control #:
US-00426
Format:
Word
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This service is available Monday through Friday from 8am to 4 pm EST. Using this form, you give permission to other adults to act for you, in your absence, regarding the treatment of your child.This is a legal document. Q: How should I fill out the request forms? A: You must fully complete the request form. Easily grant medical decision-making authority for your child with a custom Child Medical Consent form. Protect your child's health in any situation. Print one or more copies of the medical release form for each child. Fill out the form completely. All of the medical authorization forms I've filled out have you check off what the intended person is allowed to do.