Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
Medical Authorization With Minor In New York
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Multi-State
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US-00426
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Word;
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Using this form, you give permission to other adults to act for you, in your absence, regarding the treatment of your child. This is a legal document.Use our Child Medical Consent form to let someone make medical decisions for your child in your absence. I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:. If your son, daughter, or ward will be under the age of 18 years while at New York University, it is our policy to secure your consent for medical treatment. Your electronic health information will be used only during this visit for minor consented services treatment. 2. As in the past, parents will still need to sign a consent form for every healthcare provider who treats their minor children.