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.
Medical Authorization For Minor Child In Illinois
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Multi-State
Control #:
US-00426
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Word;
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Illinois Child (Minor) Medical Consent Form. Use our Child Medical Consent form to let someone make medical decisions for your child in your absence.I authorize health and education staff and the director of to Administer patent medicine to my child(ren) as specified in a doctor's written instructions. Date. A child or youth for whom a complete medical history cannot be obtained. Please report all positive testing results to the DCFS AIDS Project at . Completing this form is critical to ensure qualified medical personnel can attend to the minor child's medical needs in an emergency. Line 14-15: Enter the signature, date and address of the parent, legal guardian or Authorized Agent giving consent to the person whose information is requested.