ContractAuthorization to Provide Medically Prescribed Treatment • November 22nd, 2022
MONTGOMERY COUNTY PUBLIC SCHOOLS MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICESRockville, Maryland 20850 AUTHORIZATION TO PROVIDE MEDICALLY PRESCRIBED TREATMENTRelease and Indemnification Agreement PART I – TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools (MCPS) and Montgomery County Department of Health and Human Services (DHHS) personnel to provide the medically prescribed treatment directed by the physician (Part II, below). I agree to release, indemnify, and hold harmless MCPS and DHHS and any of their officers, staff members, employees, or agents from lawsuit, claim demand, or action, etc., against them, for providing the treatment to this student, provided MCPS and DHHS staff are following the physician’s order as written in Part II, below. I am aware that the treatment may be provided by an officer, staff member, employee, or agent of MCPS and/or DHHS who is a non-health professional who has received training
