Little League Baseball and Softball MEDICAL RELEASE NOTE To be carried by any Regular Season or Tournament Team Manager together with team roster or International A standard medical release form is an important document that indicates your consent for your child to receive medical attention in your absence Your consent Medical Release Form for Minors Attending With A Guardian Name of Minor Child Age Date of Birth Emergency Medical Release Liability Waiver Participants Name Birthdate Street Address USA U ltimate Medical Authorization Form V 41 USA ULTIMATE 5825 Delmonico Drive Suite 350 Colorado Springs CO 80919 Web wwwusaultimateorg Email AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION I hereby authorize Baylor Scott White Health to disclose my individually identifiable health information as authoriation to disclose protected health inormationmedical records medical correspondence units site mailing address in person address telephone Title HIPAA Compliant Authorization Form For The Release Of Patient Information Pursuant To 45 CFR 164508 Author Highmark Medicare Services Created Date Medical Records Release Forms DartmouthHitchcock keeps a private secure medical record about your health You can Review the information in your medical records A medical consent form caregiver authorizes the caregiver of children to make medical decisions concerning the children in the even that the parents are not
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