what should this note say?

crazynervous

I am leaving the boys with my parents while we are in LV.   Someone mentioned yesterday leaving a note allowing them permission to get them medical attention.  Anyone know what that note should say?

DaiLyght

I have the form in a Word format if you'd like a copy

Jodi&Joe

I just always put the date span on top of the letter and then say "In our absence, we give *person's name* permission to make any and all medical decisions regarding Cameron LastName and Joseph LastName."

And then I sign it and Joe signs it.

And we leave their medical cards, obviously.

 

crazynervous

dailylight that would be great.  can I give you my email address?

jlw2505

MEDICAL TREATMENT FORM

 

Authorization to consent to treatment of a minor

 

 

We (parents names), the undersigned parents of the minors listed below, do hereby authorize Dr. x at phone number,  Clinic

 

OR who is watching them

 

OR Emergency room physician in charge at any hospital or clinic

 

To act in our place to consent to all necessary and appropriate X-ray examinations, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician or surgeon licensed to practice medicine under the laws of the state of MN or wherever you live

 

It is understood that this authorization, which is valid dates you will be gone, is given in advance of any specific diagnosis, treatment or hospital care, but is given to provide authority and power on the part of our aforesaids to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of their best medical judgment is deemed advisable, and is within sound medical practice in the community and is in the best interest of the child.

 

We assume all financial responsibility for the delivery of such care.

 

Child?s Name                          Birthdate    Blood Type          Allergies

                                None

 

Address:   

Phone:     home, Cell,  

 

 

 

 

 

 

 

 

 

MEDICAL TREATMENT FORM (cont.)

 

Doctor?s name: DR.

 

Medical Insurance Company and Policy Number

 

          Name          

          Employer    

          Member ID.            Group No.   Health Plan 

Payer ID ? Rx Bin:  , Rx Grp: Medica Choice with

 

Dental:

Delta Dental PPO/Premier

Delta Airlines

Corey Friedman

Group number:  888006-2001

Subscriber ID: 068952400

National Coverage

                  

 

                                                Signed___________________________________

                                                          (mother)

 

 

____________________________________(father)

 

 

                                                Date___

                                                          (date of parent signature)

 

County of__Hennipen__                                       

State of____Minnesota___

                                               

4Speedy

I wrote one of those but it was more like an information sheet than a letter.  It listed my contact info and my DH's contact info.  I listed my kids' full names, birthdates and stated "no known allergies" next to their names.

Below that, I listed the Name and contact info of our pediatrician.

Then I photocopied our insurance card onto the page.

below that, I wrote, "I give the following people authorization to obtain medical treatment for my children (names) if I am not available.  Then I listed the people (my mom, my sister, my SIL) with their contact info.  I signed the bottom and had it notarized.  I put it in a plastic sleeve along with mapquest directions to our pediatrician.  The sleeve is taped to the inside of the cabinet next to our kitchen phone.  (I forgot, it also has our address on it in case our baby sitter has to call an ambulance).  Our babysitter knows she needs to grab it if she ever has to take our kids to the doctor.  I have about 4 notarized originals and I also pack it with my kids if they ever spend the night with family members.

katie277s

I make a copy of his insurance card and my ID and underneath, I date it and say "Please allow "insert name here" permission to seek medical treatment on DS if necessary."  Then I print and sign my name.  I do this yearly for my mom and MIL.