Get Medical Affidavit

Filling out the Medical Affidavit online is a straightforward process that helps ensure individuals receive the necessary health care services. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the Medical Affidavit

1. Click ‘Get Form’ button to access the Medical Affidavit and open it in the online editor.
2. In the first section, provide your name as the attending physician. This identifies you as the individual responsible for the patient’s care.
3. Next, enter the full name of the patient who resides at the address specified. This ensures that the application is linked to the correct individual.
4. Fill in the address details of the patient, including street address, city, and any relevant apartment or unit numbers.
5. Indicate the Residential Permit Parking Area number where the patient resides. This information is crucial for parking permit approval.
6. Confirm the patient's health care requirement during the time the Residential Parking ordinance is in effect. This statement provides justification for the permit.
7. At the bottom of the section, sign and date the affidavit to affirm that the information provided is true and correct under penalty of perjury.
8. Next, include your physician’s license number to validate your qualifications as a health care professional.
9. In the next section, provide the name of the health care professional attending to the patient, ensuring clarity in representation.
10. Sign and date the health care professional's section, reinforcing the truthfulness of the affidavit.
11. If applicable, indicate if the permit will be transferrable among multiple caretakers by checking ‘YES’ or ‘NO’. If yes, skip filling out the vehicle information.
12. If the permit is not transferrable, fill in the vehicle details, including the year and make of the vehicle and the license plate number.
13. Finally, review the completed form for accuracy and completeness. Once satisfied, you can save your changes, download, print, or share the form as needed.

Complete your Medical Affidavit online today for efficient processing!