Medical Treatment Authorization Form Template

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Copy this medical treatment authorization form model in your 123FormBuilder account, then make your own modifications to have it match your needs.

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About this template

If you’re a healthcare provider, use this medical treatment authorization form template to obtain consent to choose medical treatment for a minor patient. Copy this template in your 123FormBuilder account and edit it to fit your healthcare organization’s standards and data collection policy using our form builder. Share it with your staff and simplify the onboarding process while keeping data safe and secure and all parties protected.

Frequently Asked Questions

What is medical treatment authorization?

A medical treatment authorization permits a doctor to offer medical care to a child if their parent or legal guardian does not accompany the child.

What should I include in a medical treatment authorization form?

Ask for the personal and contact details of the patient, their parent’s information, attending physician, and insurance details (if applicable).
You can easily customize the template from 123FormBuilder, so feel free to add any information that makes the patient intake easy, safe, and comprehensive. You need to adhere to HIPAA best practices when it comes to handling protected health information through this form in the United States. 123FormBuilder’s HIPAA compliance for online forms grants you the compliance you need on our Enterprise plan.

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