Family Doctor definition

Family Doctor. Last Name: First Name: Address: Phone: City: State: Zip Code:

Family Doctor. Doctor’s Phone: Medical Concerns to be Shared with Coaches: NOTE: ALL STUDENTS TRYING OUT/PRACTICING FOR A SPORT MUST HAVE A CURRENT PHYSICAL EXAM ON FILE WITH THE SCHOOL NURSE. A CURRENT PHYSICAL EXAM IS ONE THAT HAS BEEN COMPLETED WITHIN TWELVE MONTHS OF THE LAST DAY OF THE SEASON. PHYSICALS ARE VALID FOR ONE CALENDAR YEAR. o o Is your student covered under a school insurance policy? Yes No If not, your signature constitutes a waiver and a confirmation of other insurance coverage: Insurance Company: Policy Number: Athletic participation fee is $125 per sport (fee is waived for the third season if an athlete has already participated in two previous sports, or qualifying activities, in the current school year). Parent/Guardian:

Family Doctor means being registered and in good standing with the College of Physicians and Surgeons of Ontario to conduct a practice in Family Medicine;

Examples of Family Doctor in a sentence

• Signature of Parent or Guardian Family Doctor Phone Hospital Preference Our School Nurse program is staffed by nurses from Community Health Network and will provide limited services to all students, including but not limited to - screening for signs of illness, first aid/emergency care, referral to health providers in the community, nutrition services, health education, health screenings and immunization information.

• Medication my child is taking at present: Family Health Plan carrier number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions.

• Emergency Contact Phone Number ( ) Medical Insurance Policy Number Member’s Name Phone Number ( ) Family Doctor Phone Number ( ) In the event of an emergency, the undersigned hereby give(s) permission to be transported to a hospital.

• Family Doctor Phone Family Dentist Phone Family Health Plan Carrier Policy Number I also agree to provide the Pastor, the designated Youth Ministry representatives, Chaperon or adult volunteer with current telephone numbers at which I can be reached, as well as the names and phone numbers of individuals who are likely to know where I am should an emergency arise.

• In the event of any emergency, if you are unable to reach me at the above numbers, contact Name/Relation Emergency Phone Number OPTIONAL MEDICAL INFORMATION: Medication my teen is taking at present: Family Health Plan carrier number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions.

• Emergency Information Name Birth Date Grade Gender Student’s Current School Parent's (Guardian) Name Address Cell or Home Phone Parent's daytime phone number Parent’s Email If parents cannot be contacted notify Phone Family Doctor Dr. Phone Known Allergies Insurance Carrier If student is not insured, parent assumes all medical responsibilities.

• Signature of Parent or Guardian Family Doctor Phone Hospital Preference School Clinics are staffed by Community Health Network RNs/LPNs/CMAs. A consent to treat form must be signed (included) for your child to be seen in the clinic.

• In the event of any emergency, if you are unable to reach me at the above numbers, contact Name/Relation Emergency Phone Number OPTIONAL MEDICAL INFORMATION: Medication my child is taking at present: Family Health Plan carrier number: Family Doctor: Phone Number: As Parent or Guardian, I agree to all of the above stated considerations and conditions.

• In the event of an emergency, if you are unable to reach me at the above numbers, contact: Name: Name Relationship Phone # Medical Information: Concerns we should be aware of/Medication information: Family Health Plan & carrier number: Family Doctor: Phone: Medication Administration Permission (Circle and initial all that apply): Advil Tylenol Benadryl As parent or guardian, I agree to all of the above stated considerations and conditions.

• Medications (if any): Allergic to (if any): I acknowledge that the Minor suffers from the following conditions: Family Doctor: Phone Number: ( ) I, in my own behalf and on behalf of the Minor, hereby warrant that I have read this Participant Release and Waiver Form in its entirety and fully understand its contents.

More Definitions of Family Doctor

Family Doctor. Phone: Hospital: Known Allergies: Alternate Emergency Contact Name(s): Relationship: Phone(s): OR SPECIAL EDUCATION NEEDS DISCLOSURE (Required at time of registration): Is this student, or has he/she ever been served at any time in their schooling with Special Education Modifications ? YES NO ** If student is served at their school as a Special Ed student, the most current IEP must be filed in the DTC Office prior to course start date in order for student to be served. Please, Do Not withhold this information, as it means the success and safety of your child.

Family Doctor. Name: Address: Phone: Are your child’s immunisation records up to date? ◼ Yes ◼ No (please provide a copy for file) If my child is unwell I will arrange for my child to be collected from the centre, within an hour of being contacted. I understand that my child cannot attend the centre if they are sick/infectious.