Form LIC 627B. Consent For Emergency Medical Treatment - Children's Residential Facilities - California

Form LIC 627B is used in California by children's residential facilities to obtain consent from parents or legal guardians for emergency medical treatment on behalf of a child in their care. The main purpose of this form is to ensure that appropriate medical care can be provided promptly in case of emergencies.

The form consists of sections where the parent or legal guardian's information is recorded, including their name, contact details, and signature. It also includes sections to provide authorization for emergency medical treatment, consent for transportation to a medical facility, information about the child's medical insurance, and any known allergies or medical conditions. The form may also contain space for additional instructions or restrictions related to emergency medical care.

Important fields on this form include accurately capturing the parent or legal guardian's consent, providing clear instructions regarding emergency medical treatment and transportation, and ensuring that relevant medical information about the child is included. It is crucial for the children's residential facility to have this form on file to facilitate prompt and appropriate medical care in case of emergencies.

Application Example: A child is enrolled in a children's residential facility in California. As part of the admission process, the parent or legal guardian would be required to complete Form LIC 627B to authorize emergency medical treatment for the child. By signing the form, the parent or legal guardian grants permission for necessary medical interventions to be undertaken if the child requires emergency care while at the facility.