Get Lic 627a

Filling out the Lic 627a form is an essential step for parents or authorized representatives to provide consent for emergency medical treatment for their child. This guide will walk you through each section of the form, ensuring that you understand how to correctly complete it online.

Follow the steps to successfully complete the Lic 627a form.

1. Click the ‘Get Form’ button to access the Lic 627a form and open it in the editor.
2. In the first field, enter the name of the facility where consent is being granted, which in this case is 'Children's Campus at SF State'.
3. Next, input the child's name for whom the consent for emergency medical or dental care is being provided.
4. Indicate any medication allergies that the child may have in the designated section to ensure medical personnel are aware.
5. Provide the date on which you are filling out this form, making sure it is current.
6. Sign the form in the specified area as the parent or authorized representative, ensuring that your signature is clear and legible.
7. Fill in your home address to provide contact information associated with the consent.
8. Enter your home and work phone numbers in the respective fields, making sure they are accurate for emergency contact.
9. After completing all fields, you can save changes, download, print, or share the form as needed.

Complete your Lic 627a form online today to ensure your child's medical needs are met in emergencies.