Consent for Emergency Treatment. I authorize the University of Wisconsin – Green Bay and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I AGREE TO BE RESPONSIBLE FOR ALL NECESSARY CHARGES INCURRED BY ANY HOSPITALIZATION OR TREATMENT RENDERED PURSUANT TO THIS AUTHORIZATION.
Appears in 11 contracts
Samples: Assumption of Risk Agreement, Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment, Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment
Consent for Emergency Treatment. I authorize the University of Wisconsin – Wisconsin-Green Bay and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I AGREE TO BE RESPONSIBLE FOR ALL NECESSARY CHARGES INCURRED BY ANY HOSPITALIZATION OR TREATMENT RENDERED PURSUANT TO THIS AUTHORIZATIONagree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization.
Appears in 3 contracts
Samples: Assumption of Risk Agreement, Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment, Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment
Consent for Emergency Treatment. I authorize the University of Wisconsin – Wisconsin-Green Bay and its designated representatives to consent, on behalf of my behalfxxxx, to authorize and consent to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I AGREE TO BE RESPONSIBLE FOR ALL NECESSARY CHARGES INCURRED BY ANY HOSPITALIZATION OR TREATMENT RENDERED PURSUANT TO THIS AUTHORIZATIONagree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization.
Appears in 2 contracts
Samples: Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment, Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment
Consent for Emergency Treatment. I authorize the University of Wisconsin – Wisconsin-Green Bay and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I AGREE TO BE RESPONSIBLE FOR ALL NECESSARY CHARGES INCURRED BY ANY HOSPITALIZATION OR TREATMENT RENDERED PURSUANT TO THIS AUTHORIZATION.agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization. Signature: Date: Signature of Parent or Guardian
Appears in 1 contract
Samples: Participation Waiver
