Fillable CONSENT FOR EMERGENCY MEDICAL TREATMENT- Child Care Centers

Fill Online, Printable, Fillable, Blank CONSENT FOR EMERGENCY MEDICAL TREATMENT- Child Care Centers Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

CONSENT FOR EMERGENCY MEDICAL TREATMENT- Child Care Centers

On average this form takes 3 minutes to complete

The CONSENT FOR EMERGENCY MEDICAL TREATMENT- Child Care Centers form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 10 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
( )( )
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CONSENT FOR EMERGENCY MEDICAL TREATMENT-
Child Care Centers Or Family Child Care Homes
AS THE PARENT OR AUTHORIZED REPRESENTATIVE, I HEREBY GIVE CONSENT TO
_________________________________________ TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE
FACILITY NAME
PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST (D.D.S.) FOR
__________________________________________________ . THIS CARE MAY BE GIVEN UNDER
NAME
WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL BEING OF THE CHILD
NAMED ABOVE.
DATE PARENT OR AUTHORIZED REPRESENTATIVE SIGNATURE
CHILD HAS THE FOLLOWING MEDICATION ALLERGIES:
HOME ADDRESS
HOME PHONE
LIC 627 (9/08) (CONFIDENTIAL)
WORK PHONE
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

CONSENT FOR EMERGENCY MEDICAL TREATMENT- Child Care Centers

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document