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Get and Sign Medical Treatment Consent Form Healthcare Providers Thedacare 1997-2022
EMPLOYED AT HOME PHONE BUSINESS PHONE IF PARENTS ARE NOT AVAILABLE IN AN EMERGENCY CONTACT Name Phone Number Address Relationship to Child CHILD S DOCTOR FAMILY DOCTOR CHILD IS ALLERGIC TO MEDICAL INFORMATION including last Tetanus Shot major illness INSURANCE COMPANY POLICY NUMBERS RESPONSIBLE PARTY Dear Parent or Guardian This card should be presented to the attending physician if your child is in need of medical treatment during your absence. Have each or your minor children through age 18...
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