Get Va Arlington County Government Ccs019 2019-2025

Filling out the VA Arlington County Government CCS019 form is an essential step for parents or guardians who wish to provide emergency medical consent for their child. This guide offers a detailed, step-by-step process that helps users navigate the online form seamlessly.

Follow the steps to fill out the VA Arlington County Government CCS019 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the parent or guardian section. Enter the name of the parent or guardian in the designated field.
3. Fill in the address of the parent or guardian accurately to ensure correct contact information during emergencies.
4. Provide a telephone number where the parent or guardian can be reached at any time.
5. In the emergency contact section, input the name of a relative, friend, or other responsible person who can be contacted if the parent or guardian cannot be reached.
6. Complete the address for the emergency contact person to ensure they can quickly be located.
7. Enter the telephone number of the emergency contact person to facilitate prompt communication if required.
8. In the emergency medical authorization section, write the name of the family day care provider who will be authorized to obtain medical consent on behalf of the child.
9. Fill in the child's name who will be receiving emergency medical attention if necessary.
10. Include the physician or clinic's name and address that the child usually visits or is associated with.
11. Write down the preferred hospital for emergencies that the child should be taken to if needed.
12. The parent or guardian must provide their signature in the space provided to authorize the contents of the form.
13. Date the form by entering the current date when the form is being filled.
14. Lastly, provide the name of the insurance company or Medicaid along with its address and telephone number.
15. Include the policy or Medicaid number for reference during emergencies.
16. Once all fields are completed, users can save changes, download, print, or share the form as needed.

Complete your VA Arlington County Government CCS019 form online today for peace of mind regarding emergency medical consent.