Thanks I did find one
MEDICAL CARE AUTHORIZATION

Name of Child (children):
____________________________________________________________

Name of the person, I the undersigned, have given permission for caring for
Child(children):

____________________________________________________________________________
_____

Here is where I can be reached while away including phones and locations.

____________________________________________________________________________
______

____________________________________________________________________________
______

____________________________________________________________________________
______

I hereby authorize the person(s) named above to sign for medical treatment
of my child(ren) between the following dates:

From: __________________ Until: ___________________

Parent Signature: ________________________ Date: ____________________

Witnessed By: ___________________________________________________

Phone: _________________________________________________________

Address: ________________________________________________________

Insurer: __________________________ Number: _______________________

MEDICAL CARE INFORMATION

Child's full name: _________________________________________________

Date of Birth: __________________ Date last Tetanus Shot:
______________________

Child is allergic to the following medications:
_______________________________________ ( ) None

Child is taking the following medications:
_________________________________________ _ ( ) None

Child is diabetic, has other chronic condition or major illness:

____________________________________________________________________________
_ ( ) None

Name of primary care physician and phone
number___________________________________________



----- Original Message -----
From: "Currie Reita" <reita_currie@...>
To: <ParishNurse@yahoogroups.com>
Sent: Wednesday, November 10, 2004 5:18 PM
Subject: RE: [ParishNurse] permission for medical treatment form


>
> I do not know of anything on line but I have done these for my family by
just writing up a simple permission letter and signing and having it
notarized. It worked for the camp, childcare that I was working with. I hope
this helps. I don't think it needs to be fancy but notarized is important.
>
> Reita Currie, RN BS
> Health Ministry Coordinator
> Mercy Regional Health Center
> 1823 College Ave. PO Box 1289
> Manhattan, KS 66502
> 785-565-4711
>
>
>
> -----Original Message-----
> From: janet [mailto:captpitt@...]
> Sent: Wednesday, November 10, 2004 1:24 PM
> To: IHP-NET; bokinski@...; ParishNurse@yahoogroups.com
> Subject: [ParishNurse] permission for medical treatment form
>
>
>
> Does anyone know of an online form to grant permission for medical
treatment for caregivers or relatives of children?
>
> [Non-text portions of this message have been removed]
>
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