Get Legacy Health System Childrens Emergency Consent Form

Filling out the Legacy Health System Childrens Emergency Consent Form online is essential for ensuring that your child receives timely emergency medical care in your absence. This guide will provide you with clear and detailed instructions on completing each section of the form effectively.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in the designated editor.
2. In the first section, you will need to provide authorization details. Fill in the blank with the name of the individual who will be providing consent for medical treatment. Specify the start and end dates of this authorization period.
3. Next, enter your child's full name, date of birth, social security number, and any chronic illnesses they may have. This information is vital for medical personnel to have on hand during an emergency.
4. Provide details on any allergies your child has, as well as current medications they are taking. This will help healthcare providers tailor treatment appropriately.
5. Record the date of your child’s last tetanus immunization to ensure they are up to date on necessary vaccinations.
6. Input your physician’s name and telephone number for medical reference. Include your home address, phone number, and employer details along with your employer's contact information.
7. Fill in your health insurance information, including the insurance company name, member number, group number, policy holder's name, and their date of birth.
8. Identify an emergency contact other than yourself, providing their name and telephone number.
9. Finally, ensure to sign the form with your name as the parent or guardian and include the date of signing.
10. Once completed, you can save the changes, download, print, or share the filled-out form as needed.

Complete the Legacy Health System Childrens Emergency Consent Form online today to ensure your child’s safety during emergencies.