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  • University Of Michigan Pod-0053 2005

Get University Of Michigan Pod-0053 2005-2025

of Minor: Name REG No. Date of Birth: (dd/mm/yyyy) Known Allergies/Drug Sensitivities: Known Medical Conditions: Any Limitations to Delegation: HMO/Insurance/Health Benefits and Physician Information: Company/Government Program Name: Member I.D.: Minor’s Physician Name: Phone: Minor’s Dentist Name: Phone: I/we are the parent(s) or legal guardian(s) of the above named minor. We appoint (in order of appearance): Name: Phone: Address: DL or State ID #: Name: Phone: Address: D.

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How to fill out the University of Michigan POD-0053 online

Filling out the University of Michigan POD-0053 is an essential step for parents who wish to ensure their child's medical needs are met during periods of absence. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the University of Michigan POD-0053 online.

  1. Press the ‘Get Form’ button to access the POD-0053 form and open it in the online editor.
  2. Input the name of the minor in the designated field along with their date of birth using the format dd/mm/yyyy.
  3. List any known allergies or drug sensitivities specific to the minor.
  4. Include any known medical conditions that may affect treatment decisions.
  5. Clearly specify any limitations to the delegation of parental rights, ensuring that the terms are specific (e.g., necessary surgery okay but no cosmetic procedures).
  6. Provide information about the health insurance or benefits plan under which the minor is covered, including the company or government program name and member ID.
  7. Enter the minor’s physician's name, contact number, and the name and contact number of the minor’s dentist.
  8. Designate individuals who will be granted the authority to consent to healthcare by providing their names, contact information, addresses, and IDs.
  9. Select the types of care that you are delegating authority for by marking the appropriate sections (medical, dental, surgical care, hospitalization) as applicable.
  10. Ensure at least one parent or legal guardian signs the form, and have the signature witnessed by an unrelated person or notarized.
  11. Review the form for any incomplete sections and ensure clarity of all information provided; print neatly.
  12. After completing the form, save your changes, and proceed to download, print, or share the form as necessary.

Complete the University of Michigan POD-0053 online today to ensure your child's medical needs are met when you cannot be present.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232