OT - Would you sign this form?Submitted by Kinsjon on Mon, 09/21/2009 - 16:00
Just wanted other opinions as we have received this document 4 times from school and have refused to sign it. Would you sign this? The form also asks for my childs insurance carrier and policy number and the names, addresses and phone numbers of her pediatrician, dentist and family doctor. Below is the language word for word which requires a signature.
In presenting my (our) child for diagnosis and treatment
I/we as parents/guardians hereby voluntarily consent to the rendering of such care and medical treatment, including diagnostic procedures and blood transfusions, by authorized pre hospital personnel and members of the hospital staff, as may in their professional judgment be necessary or in the best interests of my/our child.
I/we hereby acknowledge that no guarantees have been made to me as to the effect of such examinations or treatment on child's condition.
In addition I/we hereby give my/our consent to:
Name of school
who will be caring for my/our Son/Daughter for the period
July 2009 – May 2010
to arrange for routine or emergency medical/dental care and treatment necessary to preserve the health of my/our child.
I/we acknowledge that I am (we are) responsible for all reasonable charges in connection with care and treatment rendered during this period.
I/we understand that important medical information will be shared with school personnel as needed for the safety of each student. I/we have read this form and I/we certify that I/we understand its content.