AUTHORIZATION FOR TREATMENT TO MINORS I We the undersigned, parent(s) or legal guardian of the minor listed below: Birth date: do hereby authorize any x-ray examination, anesthetic, dental, medical or surgical diagnosis - Consent to Treatment - Document - PDFSEARCH.IO

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	AUTHORIZATION FOR TREATMENT TO MINORS I/We the undersigned, parent(s) or legal guardian of the minor listed below: Birth date: do hereby authorize any x-ray examination, anesthetic, dental, medical or surgical diagnosis Add to Reading List Document Date: 2014-07-09 10:48:10 Open Document File Size: 238,62 KB Share Result on Facebook City Tulsa / / Facility Hotel Phone Numbers / / IndustryTerm transportation / medical insurance plan / / MedicalCondition Migraine Headaches / Spine injury / Seizures / Fainting / Epilepsy / High Blood Pressure / Allergies/Asthma / Dizziness / Chronic / Diabetes/Blood Sugar Disorders / / MedicalTreatment surgical treatment / / Organization Miss Oklahoma Organization / / Person Deidra Stobaugh / Shannon Nation / Julie Enlow / Wendi White / / Position physician / Custodian / temporary custodian / dentist / said physician / / ProvinceOrState Oklahoma / Creek County / / Technology cellular telephone / x-ray / / SocialTag Military occupations Dentist Medical diagnosis Health insurance Informed consent Medicine Health Health sciences

AUTHORIZATION FOR TREATMENT TO MINORS I/We the undersigned, parent(s) or legal guardian of the minor listed below: Birth date: do hereby authorize any x-ray examination, anesthetic, dental, medical or surgical diagnosis Add to Reading List