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Medical Treatment Authorization for Minor Form

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Medical Treatment Authorization for Minor Form

Life happens. Sometimes you may need to have someone else bring your child in for their medical appointment. Plan ahead and be ready for this.

Medical Treatment Authorization for Minor Form

Complete the Authorization Form

Print this form and/or ask our healthcare team if you would like to complete the Medical Treatment Authorization for Minor form. Return this form to the RMC Health Information Management Department.

Mon-Fri │ 8AM-4:30PM
PO Box 359, Manchester, IA 52057
medicalrecords@regmedctr.org