
U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-5484I (Rev. 04-05) CHILD DEVELOPMENT SERVICES MEDICAL CONSENT AUTHORIZATION (TO BE USED BY CIVILIAN FAMILY MEMBERS ONLY) Instructions: Fill.
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How to fill out the CG5484I.pdf. Child Development Services - Medical Consent Authorization - Uscg online
The CG5484I.pdf is a crucial document that allows parents or guardians of a child in the Child Development Services program to authorize medical treatment. This guide will provide step-by-step instructions to help you complete the form accurately and ensure that your child's medical needs are met in a timely manner.
Follow the steps to complete the medical consent authorization form.
- Click the ‘Get Form’ button to access the form and open it in your preferred editor.
- In the first section, provide your name as the parent or legal guardian of the child. Make sure to fill in all sections accurately to avoid any issues later.
- Enter the child's full name, age, address, and phone number. Ensure that all information is correct to facilitate quick communication.
- Next, provide the insurance company's name and address. Include information for the insured person, such as their name, employee ID number, employer's name, employee address, and the insurance ID card number.
- Specify the insurance effective date to ensure there is no lapse in coverage during emergencies.
- Appoint an attorney-in-fact by selecting the Child Development Center Director or the most senior personnel available during an emergency. This individual will have the authority to consent to medical treatments for your child.
- Include the start date of the authorization, ensuring it is current and valid. Also, specify an expiration date for the authorization, which can be up to one year from the start date.
- Sign and date the form as the parent or guardian. Make sure all signatures are completed before submission.
- This document requires notarization; ensure you have a Notary Public complete the necessary sections after you sign the form to validate it.
- Once completed, review the form for accuracy. You can then save the changes, download, print, or share the form as needed.
Complete your CG5484I document online today to ensure prompt medical care for your child.
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