Medical Treatment Authorization for Minor Form

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.

Complete the Authorization 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

Pediatric Visitor RestrictionsCLICK HERE for details