Medical Authorization, Release and Waiver AgreementMedical Authorization, Release and Waiver Agreement • December 17th, 2016 • California
On behalf of myself, my heirs and my assigns, I hereby release and waive any and all claims related to my medical treatment against Authorized Persons, including but not limited to the selection of any medical, professional, or course of treatment, any authorization given or refused, any consent, failure to provide consent or measures taken or not taken to obtain medical treatment, or failure to obtain prior authorization or any other procedures required by any insurer that I may have. I understand that no person authorized to provide information or authorization is obliged to obtain medical treatment for me (or my child) or to transmit medical information to any person for any reason, and that this authorization and medical history is for my own convenience. This authorization does not create any rights or obligations against any Authorized Persons, and I agree to waive any claims that I may now have, ever had, or will have, and release, indemnify, defend, and hold harmless any Author
