PERMISSION TO ACCOMPANY A MINOR
georgetown medical building, suite 145 5330 n oak trafficway kansas city, mo 64118 creekwood medical building, suite 201 • seaport complex/mariner building 124 westwood's drive • liberty, missouri 64068 8490 college blvd overland park, ks • 66210 fax (816) 454-1694 www midwestmedicalspecialists com main (816) 454-0666 • vas midwest
Pre-Participation SPORTS PHYSICALS
Midwest Minor Medical is exceptional at providing family urgent care services to the Omaha community since 1982 Our commitment to our patients is to deliver the best family medical care on your schedule Millard Clinic (Millard Ave and "S" St) 14104 "S" Street Omaha, NE 68137 (402) 964-2332 Ridgeview Clinic (182nd & W Center St) 18210 Wright St
Cru Medical History & Consent-Liability/Photographic Release
Inc as adult person(s) into whose care the minor referenced herein as “Participant” have been entrusted, to consent to any x-ray, examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care, deemed to be necessary by a licensed physician in the event of failure to contact me for same
Healthcare Treatment Decision-Making Guidelines for Minors
The Midwest Bioethics Center (now the Center for Practical Bioethics) convened a task force late in 1991 to consider the implications of the Patient Self-Determination Act for the healthcare of minors because the act did not include children In the process, this group decided to expand its focus to healthcare treatment decision making for minors
UNDERAGE / MINOR PATIENT AUTHORIZATION FOR TREATMENT
UNDERAGE / MINOR PATIENT AUTHORIZATION FOR TREATMENT Dear Parent/Legal Guardian: It is the policy of MOI and its physicians that patients under the age of 18 should be accompanied by their parent/legal guardian for all appointments For initial evaluations, a parent or legal guardian MUST accompany the minor-aged patient
CHILDREN’S HOSPITAL Indian Hills Dr SWANSON Dodge St TOWERS
Midwest Minor Medical Dodge W Dodge Rd NP Dodge Real Estate Career Development LEO A DALY iat Group Douglas County Treasurer Chicago Sl Dodge st wells Fargo ATM Google Fazoli's cass st Chicago St Cox Store Children's Hòspitàl of Omaha Chicago Ct Chica go Staybridge Su Omaha 80th The UPS store Beverly Dodge St Panera Bread Natural G' Midwest
CONSENT TO TREAT MINOR CHILD
do hereby consent to any medical care by Melinda J Woofter, M D to be necessary for the welfare of my child while said child is under the care of Integrated Dermatology Group/Midwest Dermatology Centre, LLC My child is between the ages of 16-18 and will be attending appointment alone
Date MEDICAL HISTORY FORM - Midwest Bone & Joint Institute
Patient Signature (Guardian if Patient is a minor) RELEASE OF LABORATORY & X-RAY INFORMATION I hereby authorize Fox Valley Orthopedics to give lab, X-Ray, MRI, and CT results to a family member:
Innovation comes to Light
Contact your Midwest Veterinary Supply Representative for more information The Leo Minor® multipurpose LED surgical light by Sunnex Medical Design innovation meets the latest advancements in LED lighting technology — in the Leo Minor® LED surgical light Featuring a unique, patented optical solution, Leo Minor® produces a uniform and
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