Client Authorization for Emergency Medical Treatment Form

In the event emergency medical aid/treatment is required due to illness or injury during the process of participating in various activities (including but not limited to occupational therapy services, animal sessions, or other programs or activities) or while being on the property of Joy Meadows, Inc., I (client or parent/legal guardian of client if under 18 years of age) authorize a representative of Joy Meadows, Inc. to secure and retain medical treatment and transportation. If needed, I authorize release of my/ my child’s records upon request to the authorized individual or agency involved in the medical emergency treatment. I also authorize my/ my child’s licensed physician and/or medical facility to provide any medical/surgical care for me/ my child which they determine necessary or advisable. This authorization includes x-ray, anesthesia, surgery, hospitalization, medication and any treatment procedure deemed “life and limb or organ saving” by medical personnel. This authorization will only be invoked if the person being treated (myself/ my child) is unable to respond, or the emergency contact or parent/guardian (if applicable) is unable to be reached.

This provision will only be invoked if the person being treated is unable to respond or the parent/ guardian and/or emergency contact is unable to be reached or accessed. This consent will remain in effect until changed by the signee.