Example: marketing
Statewide occupational health clinics and hospitals
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Statewide Occupational Health Clinics and Hospitals (09/16/13)
www.michigan.govStatewide Occupational Health Clinics and Hospitals (09/16/13) County Name of Clinic Specialty Address City Telephone Office Hours In non-emergency work-related situations, employees must be approved to seek medical treatment from an occupational health clinic.
GENERAL CONSENT FOR PLAE PATIENTS LABEL HERE …
www.chnola.orgSignature of Responsible Party (Parent/Guardian if patient is under 18 years of age or unemancipated) X Date MM/DD/YY Time 00:00 am/pm AM PM Relationship to Patient Signature of Witness (Need only if signature by mark) X Date MM/DD/YY Time 00:00 am/pm AM PM AUTHORIZATION FOR TREATMENT: I hereby authorize the physician offices, clinics, and outpatient departments to provide medical care