This Medical Authorization Form is a limited Power of Attorney used by parent(s) to grant to another person the right to act in the place of a parent of a minor childin certain instances.
The exact powers granted are enumerated in the power of attorney, as well as the limitations upon the exercise of the power.
The person giving a power of attorney does not give up the power to exercise his or her own powers, nor give up the power to do the things he or she has granted another to do by virtue of the power of attorney.
The Powers in this Medical Authorization Form may be revoked at any time by the parent or custodian of the child.
Common Uses
When child is staying or vacationing temporarily with grandparent, relative or other person, the parent may need to grant the person having temporary custofy of the child the powers to:
Consent to Necessary Medical Care
Consent to Enrol in child in School
Consent to pick child up from shool and other places
Consent to attend church or school outings.
Act as parent on other occaisions when consent of authorized person is needed.
Hospitals, Doctors, Schools, Churches and other entities are not required to honor the Medical Authorization Form.
Although a Power of Attorney may be revoked at any time by the person granting the power, fully revoking it may sometimes be difficult to do.
A hospital, medical provider, school, church or other entity that relies upon a Power of Attorney that you have executed must have actual notification that the Power of Attorney has been revoked, or it may continue to honor it.
A Power of Attorney does not grant any powers to act after the death of the person granting it, nor after the date of expiration shown on the power. It is not a substitute for probate, nor guardianship.
This Medical Authorization Power of Attorney is not a relingquishment of the rights of a parent to the child, and takes no rights away from the parent.
Generally we can prepare a Medical Authorization Power of Attorney for you from information you furnish in the form below.
We Prepare
Two Original Medical Authorization Powers of Attorney for Execution
We Also Provide
Complete instructions for the execution and use of the Medical Authorization Power of Attorney.
Our Charge for the Service is $75.00
You May Complete The Following Form to Provide All of the Information We Need To Prepare Your Medical Authorization Power of Attorney.
If you have specific questions concerning your Power of Attorney, please E-Mail your questions. You should get a response by the next business day.
If more information is necessary we will send you an E-Mail requesting more specific information.
Power of Attorney
Questionaire
In Filling Out This Information Form, the parties will be referred to as Custodian and Attorney.
The Custodian is the person who has legal custody of the child. Generally these would be the parents, but in the event of divorce, the custodian is the parent having legal custody by court order.
Both parents should sign the form unless one parent has been given legal custody by court order.
This must be signed before a Notary Public.
The Attorney is the person who is granted the powers to act for an in behalf of the Custodian.
This Attorney does not need to sign the instrument.
Send Completed Forms To:
Full Name - First, Middle, Last:
Mailing address:
Street address or P.O. Box:
City:
State or Province:
Zip or Postal Code:
County:
Telephone:
Fax:
E-mail address:
CONFIRMATION AND PAYMENT INFORMATION
Payment May be by one of the following credit cards.
Charge to My Credit Card - - Yes
- No
American Express
Visa
Mastercard
Card Number
-
-
-
Expiration Date MM
YYYY
E-mail this form by pressing the SUBMIT button below -
OR
Complete and Sign this form and fax it to (405) 275-3627
OR
Complete and Sign this form and mail it to:
Legal Site - Internet Services
McKIMMEY LAW OFFICE, P.C.
24 E. Highland
Shawnee, Oklahoma 74801
With Your Check for $75.00, or your Credit Card Number.
OR
If you wish, you may e-mail the form to us and call us with your credit card number at 405-275-3564.
Credit Card Orders Usually Sent First Class Mail on the same day received.
Orders accompanied by check are sent upon notice by bank that check has cleared.
By returning this form by e-mail, by fax or by mail, I acknowledge and agree to the following:
I hereby certify as follows:
That I am a resident of the State of Oklahoma, and have been for more than six months prior to this date.
That I am a bona fide resident of the County shown to be my address herein.
That the Custodian of the Power of Attorney is 21 years of age or over.
That the Custodian of the Power of Attorney is mentally competent to execute the Power of Attorney.
That McKimmey Law Office, P.C. has not provided me any legal or tax services or advice concerning this matter.
Signature (if sending by fax or by mail)
__________________________________
Type your name: -
Please tell us how you found us on the Internet, i.e., what search terms, what search engines, links, etc.
- 2001 - McKimmey Law Office, P.C.
- The Imaginary Company
