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Person Authorized to Consent to Health Care

If you are authorized to make health care decisions for the patient, print this Patient Care Request form (PDF) and carefully follow the instructions on the form, including the instructions for returning it by mail. 

The Fire Department will make every effort to respond to your request as quickly as possible.  In most cases, you will receive a response within 10 working days.

If you are not authorized to make health care decisions for the patient, please choose the description that applies to you.


 

Revised May 13, 2016        

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