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Get Consent And Release Of Liability - Virginia
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How to fill out the Consent and Release of Liability - Virginia online
Filling out the Consent and Release of Liability form in Virginia is an essential step in ensuring proper transportation for minors receiving non-emergency medical services. This guide provides a comprehensive, step-by-step approach to help you accurately complete the form online.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to obtain the form and open it in an online editor.
- In the first section, enter your full name and current address where indicated. This confirms your identity as the legal guardian of the minor.
- Provide the name of the minor for whom you are giving consent. Next, fill in their age and birth date. This information is crucial for clarity and accountability.
- In the following section, consent to the minor riding with any transportation provider that works with LogistiCare Solutions, LLC. Make sure to clearly mention the name of the minor again.
- Acknowledge the minor's capabilities by confirming that they can be transported without an adult escort, will not be disruptive, will adhere to the driver’s instructions, and do not require emotional or other support. Fill in the name of the minor where prompted.
- Understand and acknowledge that if any conditions from the previous step change, LogistiCare Solutions, LLC. may need to provide an escort for the minor. Ensure you understand this responsibility.
- Agree to notify LogistiCare Solutions within 48 hours if you cease to be the legal guardian. Provide the name and address of any new legal guardian if applicable.
- Finally, sign and print your name as the guardian, then fill in the name of the minor. A witness signature and printed name are also required for validation.
- Once all fields are completed, review the form for accuracy. You can then save changes, download, print, or share the completed form as needed.
Complete your Consent and Release of Liability form online today for streamlined processing.
An investigator shall seek such consent only under circumstances that provide the person who is the prospective subject or the representative sufficient opportunity to consider whether to participate and that minimize the possibility of coercion or undue influence.
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