MEDICAL RELEASE: I, hereby, authorize the performance of any medical or surgical procedure, under local or general anesthesia which may be advised by the attending physicians of my child while a patient of any U.S. hospital. Furthermore, I request the use of any of the hospital's services or facilities which may be regarded as necessary or beneficial in the performance of the said procedure. Let this be your authority to treat and admit my child, until I am able to arrive at your hospital and formally sign the necessary papers. It is understood that this authorization is given in advance of any specific diagnosis or emergency treatment being rendered. (Please type your full name and date)
