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picture1_Consent Letter Parents 48816 | Letter To Authorize Parent Guardian To Bring Minor For Covid Testing


 167x       Filetype PDF       File size 0.11 MB       Source: www.lawrencegeneral.org


File: Consent Letter Parents 48816 | Letter To Authorize Parent Guardian To Bring Minor For Covid Testing
letter to authorize parental guardian consent for a minor to be brought for covid testing i parent guardian full name date of birth parents guardian tel authorize authorized person s ...

icon picture PDF Filetype PDF | Posted on 19 Aug 2022 | 3 years ago
Partial capture of text on file.
        Letter to Authorize Parental/Guardian Consent for a minor to be 
                   brought for COVID testing 
        
       I,__________________________, _____________________, ___________________________   
           (parent/guardian full name)               (date of birth)                  (parents/guardian Tel#) 
        
       authorize ____________________________________, ______________________________  
             (authorized person’s full name)                 (authorized person’s date of birth)        
        
       to bring my child to get tested for Covid 19. 
        
       He/she is the minor’s ______________________.     
                (relationship to minor) 
        
       My child is  _________________________________,  __________________________.        
                                             (minors full name)                                        (date of birth) 
                                                                                                                 
       Signature: ________________________________________     Date: _________________ 
        
       Instructions: 
        1.  Print clearly and use full legal name for patient/parent/guardian/authorized person.  
        2.  Email completed and signed form to screening@lawrencegeneral.org 
        3.  Authorized person must bring photo ID that matches name & DOB on this form when 
          bringing the minor for testing 
                    
        Letter to Authorize Parental/Guardian Consent for a minor to be 
                   brought for COVID testing 
        
       Yo ,__________________________, ____________________, _______________________          
             (nombre del padre/guardián)         (fecha de nacimiento)       (numero de telefono)                  
        
       autorizo a  _______________________________________ , ______________________  
                                 (nombre de persona que trae el menor)                (fecha de nacimiento) 
        
       quien es el ______________________________ 
                                       (relación con el menor)                         
        
       de ___________________________________, _________________________________,   
                                 (nombre del menor)                                   (fecha de nacimiento) 
        
       para hacerse la prueba  De Covid 19. 
        
       Firma: ________________________________________     Fecha:_________________ 
        
       Instructions: 
        1.  Print clearly and use full legal name for patient/parent/guardian/authorized person.  
        2.  Email completed and signed form to screening@lawrencegeneral.org 
        3.  Authorized person must bring photo ID that matches name & DOB on this form when 
          bringing the minor for testing 
        
The words contained in this file might help you see if this file matches what you are looking for:

...Letter to authorize parental guardian consent for a minor be brought covid testing i parent full name date of birth parents tel authorized person s bring my child get tested he she is the relationship minors signature instructions print clearly and use legal patient email completed signed form screening lawrencegeneral org must photo id that matches dob on this when bringing yo nombre del padre fecha de nacimiento numero telefono autorizo persona que trae el menor quien es relacion con para hacerse la prueba firma...

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