Authorization of Treatment. FOR CHILDREN AGE 15 AND UNDER: According to Maryland State Law, minor patients who are age 15 or under cannot legally consent to their own mental health evaluation and treatment. Evaluation and treatment of minors age 15 and under can only be approved by a biological parent or legal guardian. The consenting parent or guardian must legally possess medical decision-making rights for the minor patient. All parents or legal guardians who legally possess medical decision-making rights for the minor patient must sign the “Parental Consent to Treatment for Patients Age 15 and Under.” If the legally approved consenting adult(s) cannot attend the minor patient’s appointment, or another supervising individual will be present in the place of the legally approved consenting adult, please be aware that this individual does not have legal authority to provide “consent to treatment” for the minor patient. This includes, but is not limited to, step-parents, siblings, grandparents, aunts and uncles, God parents, and/or anyone else who does not legally possess medical decision-making rights for the minor patient regardless of physical custody. A SIGNED LETTER OF AUTHORIZATION OR WRITTEN PRE- AUTHORIZATION must be given to Gladstone Psychiatry & Wellness naming the person(s) you approve to consent to the minor patient’s evaluation and treatment on your behalf before services are rendered. Minor patients who are age 16 or older may consent to their own mental health evaluation and treatment according to Maryland State Law; therefore, consent from a parent or legal guardian is not needed for a minor patient age 16 and older in order for them to receive mental health services from Gladstone Psychiatry & Wellness, LLC.
Authorization of Treatment. If dental expenses for any of the preceding services are expected to exceed $300.00, a pre-authorization must be submitted to the Insurance Company. Where pre-approval has been granted the carrier must honour the approval for 90 calendar days.
Authorization of Treatment. The owner of the Doe or agent by signature below authorizes breeding, treatments associated with breeding, and veterinary care (emergency). will make every reasonable effort to contact the owner by telephone in the event of an emergency, illness, or injury. In the event that the Doe owner or an agent for the Doe cannot be contacted, will decide on the necessary veterinary services for the well-being of the Doe. Doe owner will pay all veterinary expenses incurred for the Doe.
Authorization of Treatment. When notified of an employee injury, the Injury Compensation Program Administrator (ICPA) will promptly authorize examination and treatment, and where appropriate, through the use of a Form CA-16, Authorization for Examination and/or Treatment and CA-20 Attending Physicians Report. The employee will be provided a Form CA-1 (Notice of Occupational Injury) or form CA-2 (Notice of Occupational Illness), and a Form CA-17 Duty Status Report, by his/her supervisor. Representatives of the Employer, a Union representative or other
Authorization of Treatment. I understand that AHS-KC does not have medical personnel available at the locations of such activities, and AHS -KC is granted permission, but not required, to authorize or administer emergency medical treatment for me at the locations of such activities. Such action or failure to act by AHS-KC shall be subject to the terms of this agreement, and AHS-KC does not assume any risk, nor any responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment or lack thereof.
Authorization of Treatment. The owner of the Doe or agent by signature below authorizes breeding, treatments associated with breeding, and veterinary care (emergency). Triple C Farm Boer Goats will make every reasonable effort to contact the owner by telephone in the event of an emergency, illness, or injury. In the event that the Doe owner or an agent for the Doe cannot be contacted, Triple C Farm Boer Goats will decide on the necessary veterinary services for the well-being of the Doe. Doe owner will pay all veterinary expenses incurred for the Doe.
